Provider Demographics
NPI:1659760296
Name:CALLAWAY, HOLLIE KAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOLLIE
Middle Name:KAY
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HOLLIE
Other - Middle Name:KAY
Other - Last Name:ARCHIBALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:435-792-1940
Mailing Address - Fax:
Practice Address - Street 1:1350 N 500 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2400
Practice Address - Country:US
Practice Address - Phone:435-792-1940
Practice Address - Fax:435-792-1692
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6478532-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical