Provider Demographics
NPI:1215081716
Name:CROSSEN, HOLLY LINN (PSYD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LINN
Last Name:CROSSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 SE ASPEN SUMMIT DR UNIT 73
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-8121
Mailing Address - Country:US
Mailing Address - Phone:503-481-3414
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST STE 618
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2217
Practice Address - Country:US
Practice Address - Phone:503-481-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1720103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent