Healthcare Provider Details

I. General information

NPI: 1275947087
Provider Name (Legal Business Name): LILLIAN HOLLARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 S HIGHWAY 27 STE 4
SOMERSET KY
42501-3124
US

IV. Provider business mailing address

5365 N HIGHWAY 25 W
WILLIAMSBURG KY
40769-7400
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-1815
  • Fax:
Mailing address:
  • Phone: 606-521-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberKY-0841
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: