Healthcare Provider Details

I. General information

NPI: 1336751064
Provider Name (Legal Business Name): HOLLY PELPHREY COUNSELOR TRAINEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7102 PIPPIN RD
CINCINNATI OH
45239-4605
US

IV. Provider business mailing address

11310 TEMPLETON DR
CINCINNATI OH
45251-4545
US

V. Phone/Fax

Practice location:
  • Phone: 513-900-1022
  • Fax:
Mailing address:
  • Phone: 513-678-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2103694
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC.2002540-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: