Provider Demographics
NPI:1154100634
Name:TUSSEY, HOLLY K
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:K
Last Name:TUSSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SEVEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8058
Mailing Address - Country:US
Mailing Address - Phone:859-779-5915
Mailing Address - Fax:
Practice Address - Street 1:1255 PROVIDENCE PLACE PKWY STE 115
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8379
Practice Address - Country:US
Practice Address - Phone:859-214-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2583511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical