Provider Demographics
NPI:1598955239
Name:SUSAN L HOLLEY PHD A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:SUSAN L HOLLEY PHD A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:661-942-4079
Mailing Address - Street 1:43535 17TH ST. W.
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-942-4079
Mailing Address - Fax:
Practice Address - Street 1:43535 17TH ST. W.
Practice Address - Street 2:SUITE 304
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-942-4079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty