Provider Demographics
NPI:1649027970
Name:LEFFHALM, HOLLY LYNN
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:LEFFHALM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 S DOBSON RD APT 1006
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-2957
Mailing Address - Country:US
Mailing Address - Phone:631-912-7810
Mailing Address - Fax:
Practice Address - Street 1:10165 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4558
Practice Address - Country:US
Practice Address - Phone:631-912-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW22052104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker