Basic Information
| Provider Information | |||||||||
| NPI: | 1700365012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOERR | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, TLLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44670 ANN ARBOR RD W STE 130 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481704085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132784601 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 44670 ANN ARBOR RD W STE 130 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481704085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132784601 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2018 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103TC0700X | 6301018056 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.