Provider Demographics
NPI:1689081317
Name:MAY, HOLLY (PHD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2704
Mailing Address - Country:US
Mailing Address - Phone:970-301-4775
Mailing Address - Fax:
Practice Address - Street 1:1610 29TH AVENUE PL
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6813
Practice Address - Country:US
Practice Address - Phone:970-221-0665
Practice Address - Fax:970-462-9240
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0002678103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11151242Medicaid