Healthcare Provider Details

I. General information

NPI: 1871278507
Provider Name (Legal Business Name): BRANDY R HOLLAWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 AVENUE P
SUNRAY TX
79086-2504
US

IV. Provider business mailing address

PO BOX 354
SUNRAY TX
79086-0354
US

V. Phone/Fax

Practice location:
  • Phone: 806-922-0242
  • Fax:
Mailing address:
  • Phone: 806-922-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number91955
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: