Provider Demographics
NPI:1306261102
Name:HOLLINGSWORTH, KELLIE (MA,, LMFT)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:MA,, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 INA AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9756
Mailing Address - Country:US
Mailing Address - Phone:307-250-8761
Mailing Address - Fax:
Practice Address - Street 1:1701 STAMPEDE AVE STE 201
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4818
Practice Address - Country:US
Practice Address - Phone:307-250-8761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLMFT-202106H00000X
WYPMFT-272106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist