Provider Demographics
NPI:1598955239
Name:SUSAN L HOLLEY PHD, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:SUSAN L HOLLEY PHD, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:661-206-8108
Mailing Address - Street 1:798 TUCKER RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-2503
Mailing Address - Country:US
Mailing Address - Phone:661-206-8108
Mailing Address - Fax:661-821-9752
Practice Address - Street 1:798 TUCKER RD STE 1
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-2503
Practice Address - Country:US
Practice Address - Phone:661-206-8108
Practice Address - Fax:661-821-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty