Provider Demographics
NPI:1396388450
Name:PRISCU, HOLLY RAE (JD, LCPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:RAE
Last Name:PRISCU
Suffix:
Gender:F
Credentials:JD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80544-0392
Mailing Address - Country:US
Mailing Address - Phone:406-570-6751
Mailing Address - Fax:
Practice Address - Street 1:8353 SADDLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8789
Practice Address - Country:US
Practice Address - Phone:406-282-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC19262101YM0800X
MTBBH-PCLC-LIC-38320101YM0800X
NVCPC5265R101YM0800X
MTBBH-LCPC-LIC-45820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty