Provider Demographics
NPI:1386977791
Name:MOOK, HOLLY ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:MOOK
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 1:2635 PIKE DR
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-3439
Mailing Address - Country:US
Mailing Address - Phone:406-447-3274
Mailing Address - Fax:
Practice Address - Street 1:111 N LAST CHANCE GULCH
Practice Address - Street 2:STE 1E
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4125
Practice Address - Country:US
Practice Address - Phone:406-447-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1030101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)