Provider Demographics
NPI:1427469089
Name:BEAN, HOLLY J (LCPC-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:BEAN
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 POWDERHORN DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8701
Mailing Address - Country:US
Mailing Address - Phone:207-871-1000
Mailing Address - Fax:
Practice Address - Street 1:125 PRESUMPSCOT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5225
Practice Address - Country:US
Practice Address - Phone:207-871-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional