Provider Demographics
NPI:1013110188
Name:ATHERTON, HOLLY E (MA, CRC, CLCP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:ATHERTON
Suffix:
Gender:F
Credentials:MA, CRC, CLCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 JUNEAU ST S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2357
Mailing Address - Country:US
Mailing Address - Phone:503-689-4424
Mailing Address - Fax:
Practice Address - Street 1:1845 JUNEAU ST S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2357
Practice Address - Country:US
Practice Address - Phone:503-689-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8515101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator