Provider Demographics
NPI:1578709978
Name:FLEET HIGGINS, HOLLY MARIE (MA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:FLEET HIGGINS
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 1:2050 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-6830
Mailing Address - Country:US
Mailing Address - Phone:503-675-3860
Mailing Address - Fax:
Practice Address - Street 1:437 N JAMES ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1007
Practice Address - Country:US
Practice Address - Phone:503-675-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional