Healthcare Provider Details

I. General information

NPI: 1962338418
Provider Name (Legal Business Name): HOLLY MEAD MEAD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 PARKWAY DR
LA MESA CA
91942-1535
US

IV. Provider business mailing address

4421 REVILLO DR
SAN DIEGO CA
92115-4139
US

V. Phone/Fax

Practice location:
  • Phone: 619-667-6064
  • Fax:
Mailing address:
  • Phone: 619-647-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number09928
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: