Provider Demographics
NPI:1598337362
Name:CORLEY, HOLLY RENEE (MA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RENEE
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:RENEE
Other - Last Name:PEBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5648 FOOTHILL BLVD SPC 8
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-4233
Mailing Address - Country:US
Mailing Address - Phone:425-577-9640
Mailing Address - Fax:
Practice Address - Street 1:5648 FOOTHILL BLVD SPC 8
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-4233
Practice Address - Country:US
Practice Address - Phone:425-577-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor