Provider Demographics
NPI:1316747637
Name:VANDUZER, HOLLY (LEP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:VANDUZER
Suffix:
Gender:
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 SPRING CREEK CT
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-8337
Mailing Address - Country:US
Mailing Address - Phone:910-382-0766
Mailing Address - Fax:
Practice Address - Street 1:644 SPRING CREEK CT
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-8337
Practice Address - Country:US
Practice Address - Phone:910-382-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4416103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool