Provider Demographics
NPI:1699288191
Name:AIT TAOUIT, HOLLY (PSYD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:AIT TAOUIT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:DANIELLE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-246-7796
Mailing Address - Fax:
Practice Address - Street 1:3055 HAMILTON MASON RD STE 203
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5307
Practice Address - Country:US
Practice Address - Phone:513-741-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07658103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP.07659OtherOHIO LICENSE