Provider Demographics
NPI:1972966976
Name:MCKENNEY, HOLLY (LCSW-BACS)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 MOSS ST APT 109
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3936
Mailing Address - Country:US
Mailing Address - Phone:504-432-6559
Mailing Address - Fax:
Practice Address - Street 1:818 MOSS ST APT 109
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3936
Practice Address - Country:US
Practice Address - Phone:504-432-6559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical