Provider Demographics
NPI:1316427727
Name:HOLLADAY, KEELEE BRIELLE (LCSW)
Entity type:Individual
Prefix:
First Name:KEELEE
Middle Name:BRIELLE
Last Name:HOLLADAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KEELEE
Other - Middle Name:
Other - Last Name:RUSHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1707 LINWOOD DR STE G
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5365
Mailing Address - Country:US
Mailing Address - Phone:870-604-4455
Mailing Address - Fax:888-977-2956
Practice Address - Street 1:126 ELLIS DR
Practice Address - Street 2:
Practice Address - City:BROOKLAND
Practice Address - State:AR
Practice Address - Zip Code:72417-8023
Practice Address - Country:US
Practice Address - Phone:405-543-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008769104100000X
AR8873-C101YM0800X
AR8873-M101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228135795Medicaid