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NPI Code Detail

MEDICARE: HOLLY WITHROW

MEDICARE: HOLLY WITHROW
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902438146
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY WITHROW
Provider Business Mailing Address
First Line : 201 S E ST
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-4709
Country : US
Telephone Number : 707-573-6960
Fax Number :
Provider Business Practice Location Address
First Line : 201 S E ST
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-4709
Country : US
Telephone Number : 707-573-6960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2020
Last Update Date : 02/05/2020

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Directions to “ HOLLY WITHROW ” Practice Location

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