Healthcare Provider Details

I. General information

NPI: 1932604469
Provider Name (Legal Business Name): JARRET MATHEW HOLLEY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 W CHURCH ST
NEWARK OH
43055-5050
US

IV. Provider business mailing address

164 NURSERY LN
COLUMBUS OH
43206-3579
US

V. Phone/Fax

Practice location:
  • Phone: 740-281-1777
  • Fax:
Mailing address:
  • Phone: 775-513-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: