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General NPI Number Information
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NPI Number | 1295872364
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Entity Type | Individual
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Provider Name | TOBY D HOLLEY LMHC
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1532 KINGSLEY AVE SUITE 112
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City | ORANGE PARK
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State | FL
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Zip | 32073-4538
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Country | US
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Telephone | 904-278-8722
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Fax | 904-278-4880
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Provider Business Mailing Address
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Address Line | PO BOX 1457
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City | ORANGE PARK
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State | FL
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Zip | 32067-1457
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Country | US
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Telephone | 904-278-8722
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Fax | 904-278-4880
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6214
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License Number State | FL
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