Provider Demographics
NPI:1417476706
Name:BAHNICK, HOLLY ELIZABETH (LMHC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:BAHNICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SOUTHCENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2547
Mailing Address - Country:US
Mailing Address - Phone:206-901-2000
Mailing Address - Fax:206-901-2010
Practice Address - Street 1:15214 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6143
Practice Address - Country:US
Practice Address - Phone:206-518-9021
Practice Address - Fax:206-299-0987
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61033925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2120381Medicaid