Provider Demographics
NPI:1609993005
Name:WITHERINGTON, HOLLI RAE (BA)
Entity Type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:RAE
Last Name:WITHERINGTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:HOLLI
Other - Middle Name:RAE
Other - Last Name:HOOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:124 S BROADWAY AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5807
Mailing Address - Country:US
Mailing Address - Phone:580-332-8773
Mailing Address - Fax:580-332-8774
Practice Address - Street 1:124 S BROADWAY AVE STE 408
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5807
Practice Address - Country:US
Practice Address - Phone:580-332-8773
Practice Address - Fax:580-332-8774
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)