=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245996743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLLY A CONLEE LMHC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2021
-----------------------------------------------------
Last Update Date | 11/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3408 WOODLAND AVE STE 102
-----------------------------------------------------
City | WEST DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50266-6504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-601-9838
-----------------------------------------------------
Fax | 515-528-7866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3215 NE 5TH LN
-----------------------------------------------------
City | ANKENY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50021-8137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-528-7856
-----------------------------------------------------
Fax | 515-528-7866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HOLLY ANN CONLEE
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 515-528-7856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------