Healthcare Provider Details

I. General information

NPI: 1437122462
Provider Name (Legal Business Name): BEVERLY OHNECK HOLLY R.N., LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N COLLEGE AVE STE. 213
BLOOMINGTON IN
47404-3972
US

IV. Provider business mailing address

115 N COLLEGE AVE STE. 213
BLOOMINGTON IN
47404-3972
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-8948
  • Fax:
Mailing address:
  • Phone: 812-333-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34002760
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number28043760
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: