Provider Demographics
NPI:1679247332
Name:PERHAM, HOLLY (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:PERHAM
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2906
Mailing Address - Country:US
Mailing Address - Phone:928-242-1459
Mailing Address - Fax:
Practice Address - Street 1:124 GARDEN ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2906
Practice Address - Country:US
Practice Address - Phone:928-242-1459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4699103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool