Provider Demographics
NPI:1770815870
Name:HOLLOWAY, DARESHA M (BHRS)
Entity Type:Individual
Prefix:MS
First Name:DARESHA
Middle Name:M
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 NW 96TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-6139
Mailing Address - Country:US
Mailing Address - Phone:405-596-7721
Mailing Address - Fax:
Practice Address - Street 1:444 NW 96TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-6139
Practice Address - Country:US
Practice Address - Phone:405-596-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00000000Medicaid