Provider Demographics
NPI:1932471562
Name:FECHTMEYER, HOLLY G
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:G
Last Name:FECHTMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 S RURAL RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5581
Mailing Address - Country:US
Mailing Address - Phone:480-317-9868
Mailing Address - Fax:480-317-9867
Practice Address - Street 1:3910 S RURAL RD
Practice Address - Street 2:SUITE J
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5581
Practice Address - Country:US
Practice Address - Phone:480-317-9868
Practice Address - Fax:480-317-9867
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical