Provider Demographics
NPI:1700493251
Name:LECKLIDER, HOLLY (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LECKLIDER
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:MYCROFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3820 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-5403
Practice Address - Country:US
Practice Address - Phone:614-566-4414
Practice Address - Fax:614-566-6846
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.00276282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry