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General NPI Number Information
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NPI Number | 1154100634
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Entity Type | Individual
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Provider Name | HOLLY K TUSSEY
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 1255 PROVIDENCE PLACE PKWY STE 115
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City | LEXINGTON
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State | KY
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Zip | 40511-8379
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Country | US
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Telephone | 859-214-7440
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Fax |
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Provider Business Mailing Address
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Address Line | 128 SEVEN OAKS DR
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City | RICHMOND
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State | KY
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Zip | 40475-8058
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Country | US
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Telephone | 859-779-5915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 258351
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License Number State | KY
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