Provider Demographics
NPI:1487973665
Name:ANTON, HOLLY (PHD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:ANTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 MIDPINE WAY
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5583
Mailing Address - Country:US
Mailing Address - Phone:707-875-6526
Mailing Address - Fax:707-827-3726
Practice Address - Street 1:105 MORRIS ST STE 200
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3826
Practice Address - Country:US
Practice Address - Phone:707-875-6526
Practice Address - Fax:707-827-3726
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18114103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY18114OtherSTATE MEDICAL LICENSE