Provider Demographics
NPI:1376965871
Name:SUELLENTROP, HOLLY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:SUELLENTROP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 JACKSON HILL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-7407
Mailing Address - Country:US
Mailing Address - Phone:713-914-0556
Mailing Address - Fax:281-200-0000
Practice Address - Street 1:303 JACKSON HILL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-7407
Practice Address - Country:US
Practice Address - Phone:713-914-0556
Practice Address - Fax:281-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500799641041S0200X
TX637421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool