MEDICARE: HOLLY DIANE CRISP M.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	2084P0800X	Psychiatry Physician	N2455	TX

General Provider Information

NPI Number	:	1619108883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY DIANE CRISP M.D.

Provider Business Mailing Address
First Line	:	4306 YOAKUM BLVD
Second Line	:	SUITE 535
City	:	HOUSTON
State	:	TX
Zip	:	77006-5851
Country	:	US
Telephone Number	:	713-665-1602
Fax Number	:	713-665-1601

Provider Business Practice Location Address
First Line	:	4306 YOAKUM BLVD
Second Line	:	SUITE 535
City	:	HOUSTON
State	:	TX
Zip	:	77006-5851
Country	:	US
Telephone Number	:	713-665-1602
Fax Number	:	713-665-1601

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

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	09/30/2024

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