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NPI Code Detail

MEDICARE: HOLLEY KENDRICK

MEDICARE: HOLLEY KENDRICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor11476TX
3101YM0800XMental Health Counselor69136TX

General Provider Information

NPI Number : 1225171481
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLEY KENDRICK
Provider Business Mailing Address
First Line : 2838 N LOOP 1604 E
Second Line : STE 104
City : SAN ANTONIO
State : TX
Zip : 78232-1711
Country : US
Telephone Number : 210-495-2117
Fax Number : 888-892-4363
Provider Business Practice Location Address
First Line : 2838 N LOOP 1604 E
Second Line : SUITE 104
City : SAN ANTONIO
State : TX
Zip : 78232-1711
Country : US
Telephone Number : 210-495-2117
Fax Number : 888-893-4363
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2007
Last Update Date : 01/12/2017

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Directions to “ HOLLEY KENDRICK ” Practice Location

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