Healthcare Provider Details

I. General information

NPI: 1124056270
Provider Name (Legal Business Name): SUSAN LOUISE HOLLEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 TUCKER RD STE 1
TEHACHAPI CA
93561-2503
US

IV. Provider business mailing address

798 TUCKER RD STE 1
TEHACHAPI CA
93561-2503
US

V. Phone/Fax

Practice location:
  • Phone: 661-206-8108
  • Fax: 661-821-9752
Mailing address:
  • Phone: 661-206-8108
  • Fax: 661-821-9752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: