Provider Demographics
NPI:1598519951
Name:SMITH, HOLLY LYNNE
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 E ASH ST # A2
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4133
Mailing Address - Country:US
Mailing Address - Phone:937-765-7882
Mailing Address - Fax:
Practice Address - Street 1:987 E ASH ST # A2
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4133
Practice Address - Country:US
Practice Address - Phone:937-765-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty