MEDICARE: HOLLY SIMPSON LPC

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	101YM0800X	Mental Health Counselor	39001805A	IN
2	101YM0800X	Mental Health Counselor	LPC03111	OK

General Provider Information

NPI Number	:	1548390420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY SIMPSON LPC

Provider Business Mailing Address
First Line	:	6846 S CANTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3412
Country	:	US
Telephone Number	:	918-745-0095
Fax Number	:	918-795-0190

Provider Business Practice Location Address
First Line	:	6846 S CANTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-3412
Country	:	US
Telephone Number	:	918-795-0095
Fax Number	:	918-795-0190

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	10/16/2023

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Directions to “ HOLLY SIMPSON LPC” Practice Location

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