Provider Demographics
NPI:1972726792
Name:PRICHARD, HOLLIS L (MFT)
Entity type:Individual
Prefix:MS
First Name:HOLLIS
Middle Name:L
Last Name:PRICHARD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:PRICHARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:7765 HEALDSBURG AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3309
Mailing Address - Country:US
Mailing Address - Phone:707-865-3153
Mailing Address - Fax:707-865-3151
Practice Address - Street 1:7765 HEALDSBURG AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3309
Practice Address - Country:US
Practice Address - Phone:707-865-3153
Practice Address - Fax:707-865-3151
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist