Healthcare Provider Details

I. General information

NPI: 1861944191
Provider Name (Legal Business Name): HOLLY HANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CLIFTY ST STE 2
SOMERSET KY
42503-1710
US

IV. Provider business mailing address

122 WOODLAND AVE
LANCASTER KY
40444-1324
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-0026
  • Fax: 606-678-0047
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number302179
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: