Provider Demographics
NPI:1912417387
Name:WARREN, HOLLY KIM (LCDC, LPC-ASSOCIATE)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:KIM
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCDC, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 ITHACA AVE STE H
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2637
Mailing Address - Country:US
Mailing Address - Phone:806-473-7127
Mailing Address - Fax:
Practice Address - Street 1:8212 ITHACA AVE STE H
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2637
Practice Address - Country:US
Practice Address - Phone:806-473-7127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health