Provider Demographics
NPI:1801802657
Name:ALASTRA, HOLLY (RD, LCPC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ALASTRA
Suffix:
Gender:F
Credentials:RD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 HARVEST LOOP
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-9414
Mailing Address - Country:US
Mailing Address - Phone:406-439-2109
Mailing Address - Fax:
Practice Address - Street 1:1984 HARVEST LOOP
Practice Address - Street 2:
Practice Address - City:EAST HELENA
Practice Address - State:MT
Practice Address - Zip Code:59635-9414
Practice Address - Country:US
Practice Address - Phone:406-439-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT432133V00000X
MT5289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT432OtherSTATE LICENSURE
MT5289OtherCOUNSELING LICENSURE