Basic Information
| Provider Information | |||||||||
| NPI: | 1538503701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRICK | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | BS, AAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 9TH AVE # MS 359797 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0627449600 | ||||||||
| FaxNumber: | 0627449854 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 9TH AVE # MS 359797 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067449672 | ||||||||
| FaxNumber: | 2067449854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2013 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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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 | CG60268956 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | CG60268956 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.