Provider Demographics
NPI:1396416871
Name:HOLLINGSWORTH, MOLLY (MED, LCPC, SEP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:MED, LCPC, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 FAIRWAY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5810
Mailing Address - Country:US
Mailing Address - Phone:406-579-4684
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRWAY DR STE 203
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5810
Practice Address - Country:US
Practice Address - Phone:406-579-4684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-48719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health