MEDICARE: MRS. HOLLY MARIE WORKMAN MA LPC NCC

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	101Y00000X	Counselor	6401007443	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	705540	OTHER	MI	AETNA INDIVIDUAL
2	1017381	OTHER	MI	MCLAREN
3	P208955410	OTHER	MI	BCBSM
4	45524700	OTHER	MI	MAGELLAN
5	MHS501770	OTHER	MI	VALUE OPTIONS
6	31107	OTHER	MI	HEALTH PLAN OF MI

General Provider Information

NPI Number	:	1821050576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY MARIE WORKMAN MA LPC NCC

Provider Business Mailing Address
First Line	:	6666 WEALTHY STREET
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48346
Country	:	US
Telephone Number	:	248-625-7010
Fax Number	:	248-625-7010

Provider Business Practice Location Address
First Line	:	8040 ORTONVILLE RD STE B
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48348-4468
Country	:	US
Telephone Number	:	248-760-5530
Fax Number	:

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	12/19/2023

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