Provider Demographics
NPI:1821129115
Name:MOBBERLEY, HOLLY PATRICE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:PATRICE
Last Name:MOBBERLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 EASTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1326
Mailing Address - Country:US
Mailing Address - Phone:612-214-6357
Mailing Address - Fax:
Practice Address - Street 1:301 4TH AVE S
Practice Address - Street 2:SUITE 780N, MC L605
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1015
Practice Address - Country:US
Practice Address - Phone:612-596-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN156321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical