Provider Demographics
NPI:1932140282
Name:HOLLY, PETER N III (MA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:N
Last Name:HOLLY
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CENTRAL AVE S
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848
Mailing Address - Country:US
Mailing Address - Phone:509-787-4466
Mailing Address - Fax:509-787-1031
Practice Address - Street 1:203 CENTRAL AVE S
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848
Practice Address - Country:US
Practice Address - Phone:509-787-4466
Practice Address - Fax:509-787-1031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00020445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health