Provider Demographics
NPI:1861856106
Name:HENGARTNER, HOLLY (LPCC-S)
Entity Type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:
Last Name:HENGARTNER
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:CHALKWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1662 MARS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3825
Mailing Address - Country:US
Mailing Address - Phone:216-282-3838
Mailing Address - Fax:216-801-4370
Practice Address - Street 1:1662 MARS AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3825
Practice Address - Country:US
Practice Address - Phone:216-282-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800599-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268433Medicaid