MEDICARE: GLENN HOLLY LCSW

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
1	104100000X	Social Worker	19186	AZ

General Provider Information

NPI Number	:	1275200818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN HOLLY LCSW

Provider Business Mailing Address
First Line	:	14210 W ROBERTSON DR
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-2247
Country	:	US
Telephone Number	:	720-315-6957
Fax Number	:

Provider Business Practice Location Address
First Line	:	14210 W ROBERTSON DR
Second Line	:
City	:	SUN CITY WEST
State	:	AZ
Zip	:	85375-2247
Country	:	US
Telephone Number	:	720-315-6957
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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Directions to “ GLENN HOLLY LCSW” Practice Location

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