Provider Demographics
NPI:1962193946
Name:HOLLIS, AMY LISETTE (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LISETTE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5204
Mailing Address - Country:US
Mailing Address - Phone:682-553-5596
Mailing Address - Fax:
Practice Address - Street 1:8408 DAVIS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8685
Practice Address - Country:US
Practice Address - Phone:817-765-5664
Practice Address - Fax:817-918-7307
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67760101YM0800X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker