=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952007015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOLLIE COLWICK LPCA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2023
-----------------------------------------------------
Last Update Date | 01/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 S SHERRIN AVE STE 210
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-758-0608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1908 HUNTERS TRCE
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-8200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-797-5154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 282484
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------