Provider Demographics
NPI:1205970761
Name:WHITAKER, HOLLY S (MA, LPCC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:S
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 101ST AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-3201
Mailing Address - Country:US
Mailing Address - Phone:651-439-2059
Mailing Address - Fax:888-675-8262
Practice Address - Street 1:1360 ENERGY PARK DR STE 330
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5298
Practice Address - Country:US
Practice Address - Phone:651-439-2059
Practice Address - Fax:888-675-8262
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0008095101YP1600X, 101YP2500X
MNCC01515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional