Provider Demographics
NPI:1568013894
Name:MONTE, HOLLY A (MA TLLP)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:A
Last Name:MONTE
Suffix:
Gender:F
Credentials:MA TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4727
Mailing Address - Country:US
Mailing Address - Phone:517-803-1545
Mailing Address - Fax:
Practice Address - Street 1:910 W LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4727
Practice Address - Country:US
Practice Address - Phone:517-803-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018058103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist