Provider Demographics
NPI:1619159555
Name:HARRISON, HOLLY ELIZABETH (LBSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:BOYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:1375 R DALE WERTZ DR
Mailing Address - Street 2:PO 312
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48475
Mailing Address - Country:US
Mailing Address - Phone:989-269-9293
Mailing Address - Fax:989-269-7544
Practice Address - Street 1:1375 R DALE WERTZ DR
Practice Address - Street 2:PO 312
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1365
Practice Address - Country:US
Practice Address - Phone:989-269-9293
Practice Address - Fax:989-269-7544
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085998104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker