Provider Demographics
NPI:1699019208
Name:HOOTON, HOLLY MARIE
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:MARIE
Last Name:HOOTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 AZALEA AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0217
Mailing Address - Country:US
Mailing Address - Phone:530-722-9957
Mailing Address - Fax:530-722-9294
Practice Address - Street 1:668 AZALEA AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0217
Practice Address - Country:US
Practice Address - Phone:530-722-9957
Practice Address - Fax:530-722-9294
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist