Healthcare Provider Details

I. General information

NPI: 1770024705
Provider Name (Legal Business Name): HOLLY HOMAN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4696 W CHERT DR
NEW PALESTINE IN
46163-6300
US

IV. Provider business mailing address

4696 W CHERT DR
NEW PALESTINE IN
46163-6300
US

V. Phone/Fax

Practice location:
  • Phone: 317-607-5880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number34007764A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000695A
License Number StateIN

VIII. Authorized Official

Name: HOLLY ANN HOMAN
Title or Position: THERAPIST
Credential: LCSW
Phone: 317-607-5880