Provider Demographics
NPI:1497958078
Name:POMME, HOLLY ELISE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ELISE
Last Name:POMME
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1704
Mailing Address - Country:US
Mailing Address - Phone:541-704-7511
Mailing Address - Fax:503-386-2677
Practice Address - Street 1:613 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1704
Practice Address - Country:US
Practice Address - Phone:541-704-7511
Practice Address - Fax:503-386-2677
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-61791041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1497958078Medicaid
OR1669830865Medicaid