Healthcare Provider Details

I. General information

NPI: 1679058267
Provider Name (Legal Business Name): HOLLY HATCH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 FAIRFIELD DR
EL PASO TX
79925-2433
US

IV. Provider business mailing address

1508 FAIRFIELD DR # DE
EL PASO TX
79925-2433
US

V. Phone/Fax

Practice location:
  • Phone: 915-241-0472
  • Fax: 575-267-6228
Mailing address:
  • Phone: 915-241-0472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number77335
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00121188
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB20230089
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: