Healthcare Provider Details

I. General information

NPI: 1528566064
Provider Name (Legal Business Name): HOLLY LAMON ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 VOLGA AVE
DALLAS TX
75216-5762
US

IV. Provider business mailing address

2315 VOLGA AVE
DALLAS TX
75216-5762
US

V. Phone/Fax

Practice location:
  • Phone: 682-704-1926
  • Fax:
Mailing address:
  • Phone: 682-704-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: