Provider Demographics
NPI:1407250715
Name:HOLLY MCCLINTOCK, PMHNP-BC, PSYCHIATRIC SERVICES, PLCC
Entity Type:Organization
Organization Name:HOLLY MCCLINTOCK, PMHNP-BC, PSYCHIATRIC SERVICES, PLCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLINTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:515-574-9803
Mailing Address - Street 1:1728 CENTRAL AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4200
Mailing Address - Country:US
Mailing Address - Phone:515-955-1836
Mailing Address - Fax:515-955-7115
Practice Address - Street 1:1728 CENTRAL AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4200
Practice Address - Country:US
Practice Address - Phone:515-955-1836
Practice Address - Fax:515-955-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG122426251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health