Provider Demographics
NPI:1437122462
Name:OHNECK HOLLY, BEVERLY (RN, LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:OHNECK HOLLY
Suffix:
Gender:F
Credentials:RN, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N COLLEGE AVE
Mailing Address - Street 2:STE. 213
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3972
Mailing Address - Country:US
Mailing Address - Phone:812-333-8948
Mailing Address - Fax:
Practice Address - Street 1:115 N COLLEGE AVE
Practice Address - Street 2:STE. 213
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3972
Practice Address - Country:US
Practice Address - Phone:812-333-8948
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340027601041C0700X
IN28043760163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000251127OtherANTHEM
IN549190Medicare ID - Type Unspecified