MEDICARE: DR. HOLLY SALISBURY PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	4135	AZ
2	103TF0200X	Forensic Psychologist	4135	AZ

General Provider Information

NPI Number	:	1174998587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOLLY SALISBURY PSY.D.

Provider Business Mailing Address
First Line	:	2211 E HIGHLAND AVE
Second Line	:	SUITE 170
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4835
Country	:	US
Telephone Number	:	623-692-8240
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 E HIGHLAND AVE
Second Line	:	SUITE 170
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4835
Country	:	US
Telephone Number	:	623-692-8240
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	01/25/2016

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