Provider Demographics
NPI:1619108883
Name:CRISP-HAN, HOLLY DIANE (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:DIANE
Last Name:CRISP-HAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 YOAKUM BLVD
Mailing Address - Street 2:SUITE 535
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5851
Mailing Address - Country:US
Mailing Address - Phone:713-665-1602
Mailing Address - Fax:713-665-1601
Practice Address - Street 1:4306 YOAKUM BLVD
Practice Address - Street 2:SUITE 535
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5851
Practice Address - Country:US
Practice Address - Phone:713-665-1602
Practice Address - Fax:713-665-1601
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN24552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry