Healthcare Provider Details

I. General information

NPI: 1851584064
Provider Name (Legal Business Name): HOLLY M ASDELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S WALNUT ST STE. 215
SEYMOUR IN
47274-2991
US

IV. Provider business mailing address

415 S WALNUT ST STE. 215
SEYMOUR IN
47274-2991
US

V. Phone/Fax

Practice location:
  • Phone: 812-523-0386
  • Fax: 812-523-8416
Mailing address:
  • Phone: 812-523-0386
  • Fax: 812-523-8416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34005256A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: