Provider Demographics
NPI:1760673727
Name:WEST, HOLLY J (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:WEST
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:J
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:191 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT SHADE
Mailing Address - State:TN
Mailing Address - Zip Code:37145-3342
Mailing Address - Country:US
Mailing Address - Phone:615-774-3223
Mailing Address - Fax:615-774-3223
Practice Address - Street 1:1432 W MAIN ST
Practice Address - Street 2:SUITE 402
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1323
Practice Address - Country:US
Practice Address - Phone:615-444-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000002579101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376955OtherGROUP MEDICARE