Individual
SAMUEL LAWRENCE HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
815 N COLLEGE RD, TWIN FALLS, ID 83301-3484
(208) 814-9100
(208) 814-9903
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CG61210477
WA
2084P0800X
Psychiatry Physician
Primary
O-2013
ID
2084P0800X
Psychiatry Physician
OP61406164
WA
Other
Enumeration date
03/19/2019
Last updated
08/13/2024
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