Provider Demographics
NPI:1710257068
Name:HOLLEY, MELINDA MAY
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:MAY
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELINDA
Other - Middle Name:MAY
Other - Last Name:HOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1856 CEDAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4178
Mailing Address - Country:US
Mailing Address - Phone:740-687-4500
Mailing Address - Fax:740-687-4595
Practice Address - Street 1:1856 CEDAR HILL RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-687-4500
Practice Address - Fax:740-687-4595
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101164101YA0400X
172V00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker