=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124360680
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLY BLOCK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2013
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1078 S WATER AVE
-----------------------------------------------------
City | GALLATIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37066-3959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-687-1827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 540 TRIPLE CROWN CIR
-----------------------------------------------------
City | GALLATIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37066-2595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-331-5624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 9435
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------