Healthcare Provider Details

I. General information

NPI: 1467783159
Provider Name (Legal Business Name): HOLLY BETH KOZEE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 MORPHY AVE
FAIRHOPE AL
36532-2325
US

IV. Provider business mailing address

19760 HUNTERS LOOP
FAIRHOPE AL
36532-4801
US

V. Phone/Fax

Practice location:
  • Phone: 251-616-1040
  • Fax: 251-616-1044
Mailing address:
  • Phone: 251-616-1040
  • Fax: 251-616-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34294
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1238
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number34294
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2170
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1238
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number2170
License Number StateAL
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2170
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: