Provider Demographics
NPI:1760416671
Name:GREGORY, HOLLY NICOHLE (LCSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:NICOHLE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 S MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2784
Mailing Address - Country:US
Mailing Address - Phone:765-482-7421
Mailing Address - Fax:
Practice Address - Street 1:1005 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2784
Practice Address - Country:US
Practice Address - Phone:765-482-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005897A1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool