Basic Information
| Provider Information | |||||||||
| NPI: | 1043497068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1208 | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814021208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702522500 | ||||||||
| FaxNumber: | 9702523208 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 MIAMI RD | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814014108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702499694 | ||||||||
| FaxNumber: | 9702492955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 06/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LH60450840 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | CG60124138 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | LPC0012730 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.