Provider Demographics
NPI:1649785775
Name:MILLER, HOLLY NICHOL (LMHC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:NICHOL
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, LLC
Mailing Address - Street 1:1055 LONGFELLOW DR.
Mailing Address - Street 2:SUITE D
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2024
Mailing Address - Country:US
Mailing Address - Phone:319-213-1764
Mailing Address - Fax:319-409-9411
Practice Address - Street 1:1055 LONGFELLOW DR.
Practice Address - Street 2:SUITE D
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2024
Practice Address - Country:US
Practice Address - Phone:319-213-1764
Practice Address - Fax:319-409-9411
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health