Provider Demographics
NPI:1720660913
Name:MITCHELL, HOLLY D (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 TUDOR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5902
Mailing Address - Country:US
Mailing Address - Phone:907-729-8600
Mailing Address - Fax:
Practice Address - Street 1:755 A ST # 907
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3625
Practice Address - Country:US
Practice Address - Phone:907-272-1255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health