Provider Demographics
NPI:1922230531
Name:ANDERSON, HOLLY DANIELLE (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:DANIELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 HOUSTON ST STE 107
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6497
Mailing Address - Country:US
Mailing Address - Phone:816-307-2253
Mailing Address - Fax:816-379-3751
Practice Address - Street 1:322 HOUSTON ST STE 107
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6497
Practice Address - Country:US
Practice Address - Phone:816-307-2253
Practice Address - Fax:816-379-3751
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017025033106H00000X
KS839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12570785OtherCAQH