Provider Demographics
NPI:1700129178
Name:LEUPP, HOLLY A (LISW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:LEUPP
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BIEDE AVE.
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2497
Mailing Address - Country:US
Mailing Address - Phone:419-782-8856
Mailing Address - Fax:419-782-2261
Practice Address - Street 1:211 BIEDE AVE
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2408
Practice Address - Country:US
Practice Address - Phone:419-782-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1200925101YM0800X
OHI.1500086170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health