Provider Demographics
NPI:1780134221
Name:TSE, HOLLY (LMFT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:TSE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:STANGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4079 GOVERNOR DR # 178
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2522
Mailing Address - Country:US
Mailing Address - Phone:619-268-1211
Mailing Address - Fax:805-835-4493
Practice Address - Street 1:4305 GESNER ST STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6677
Practice Address - Country:US
Practice Address - Phone:619-268-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61331135106H00000X
CA112930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist