Healthcare Provider Details

I. General information

NPI: 1679886857
Provider Name (Legal Business Name): HOLLY A HILLS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 E FLETCHER AVE SUITE 250
TAMPA FL
33613-4655
US

IV. Provider business mailing address

3450 E FLETCHER AVE SUITE 250
TAMPA FL
33613-4655
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9392
  • Fax: 813-977-2478
Mailing address:
  • Phone: 813-978-9392
  • Fax: 813-977-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0004393
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY0004393
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0004393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: