Healthcare Provider Details

I. General information

NPI: 1356561773
Provider Name (Legal Business Name): PATRICIA LYNN HOLAWAY LMFT, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. LYNN HOLAWAY

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N TILLOTSON AVE
MUNCIE IN
47304
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-288-1928
  • Fax: 765-741-0310
Mailing address:
  • Phone: 765-288-1928
  • Fax: 765-741-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35002027A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: