Provider Demographics
NPI:1881109932
Name:CHRISTENSEN, HOLLY ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ANN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83448-4708
Mailing Address - Country:US
Mailing Address - Phone:208-390-3209
Mailing Address - Fax:
Practice Address - Street 1:295 N 3855 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5124
Practice Address - Country:US
Practice Address - Phone:208-745-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID37128104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker