Individual
MISTI MARIE HOLBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPP
Contact information
Practice address
321 E MAIN ST, MOREHEAD, KY 40351-1671
(606) 784-4161
(606) 783-9952
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
115956
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000226450 NONPAR
ANTHEM BCBS
—
01
—
11717037
CAQH
—
05
—
7100283710
—
KY
01
—
9488279
AETNA
—
Enumeration date
08/12/2006
Last updated
11/25/2019
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