Provider Demographics
NPI:1124442207
Name:MINER, HOLLY L (LCSW)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:L
Last Name:MINER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:HOLLY
Other - Middle Name:L
Other - Last Name:FURGESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 S. OTSEGO, GAYLORD CBOC
Mailing Address - Street 2:ALEDA E. LUTZ DEPT. OF VETERANS AFFAIRS
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1725
Mailing Address - Country:US
Mailing Address - Phone:989-732-7525
Mailing Address - Fax:989-732-6577
Practice Address - Street 1:806 S. OTSEGO, GAYLORD CBOC
Practice Address - Street 2:ALEDA E. LUTZ DEPT. OF VETERANS AFFAIRS
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1725
Practice Address - Country:US
Practice Address - Phone:989-732-7525
Practice Address - Fax:989-732-6577
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker