Provider Demographics
NPI:1184933905
Name:LISTON, HOLLY LYNETTE (LPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNETTE
Last Name:LISTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 S 2ND AVE # 1
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6903
Mailing Address - Country:US
Mailing Address - Phone:605-214-6855
Mailing Address - Fax:
Practice Address - Street 1:407 S 2ND AVE # 1
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6903
Practice Address - Country:US
Practice Address - Phone:712-476-5245
Practice Address - Fax:712-476-9621
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0013291041C0700X
SDLPC-MH30594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical