Provider Demographics
NPI:1457132920
Name:MATTOX, HOLLY (LMHP LPC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:
Last Name:MATTOX
Suffix:
Gender:F
Credentials:LMHP LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 S 204TH ST # 308
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2880
Mailing Address - Country:US
Mailing Address - Phone:913-579-2527
Mailing Address - Fax:
Practice Address - Street 1:101 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7943
Practice Address - Country:US
Practice Address - Phone:402-431-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health