Provider Demographics
NPI:1669843223
Name:DOUGHTY, HOLLY L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:L
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:HOLLY
Other - Middle Name:L
Other - Last Name:FINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:120 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2522
Mailing Address - Country:US
Mailing Address - Phone:920-415-4416
Mailing Address - Fax:
Practice Address - Street 1:120 E 4TH ST
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2522
Practice Address - Country:US
Practice Address - Phone:920-415-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI5799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100048717Medicaid