Provider Demographics
NPI:1437555281
Name:SMITH, HOLLY ANGELA (MA)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:ANGELA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 PEARL ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5343
Mailing Address - Country:US
Mailing Address - Phone:720-556-2555
Mailing Address - Fax:
Practice Address - Street 1:1445 PEARL ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5343
Practice Address - Country:US
Practice Address - Phone:720-556-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011074101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health