Provider Demographics
NPI:1699079962
Name:HOLLIER, RAEGAN (MED, LPC)
Entity type:Individual
Prefix:
First Name:RAEGAN
Middle Name:
Last Name:HOLLIER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3442
Mailing Address - Country:US
Mailing Address - Phone:409-350-8967
Mailing Address - Fax:
Practice Address - Street 1:5730 VIKING DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3442
Practice Address - Country:US
Practice Address - Phone:409-350-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional