Basic Information
| Provider Information | |||||||||
| NPI: | 1700129178 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEUPP | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 BIEDE AVE. | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197828856 | ||||||||
| FaxNumber: | 4197822261 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 BIEDE AVE | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435122408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197828856 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2013 | ||||||||
| LastUpdateDate: | 02/10/2015 | ||||||||
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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 | 101YM0800X | S.1200925 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 170300000X | I.1500086 | OH | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.