Individual
HOLLY IVIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
149 S MAIN ST, PHOENIX, OR 97535-6631
(541) 535-4133
Mailing address
1840 KIMBERLY DR, KLAMATH FALLS, OR 97603-5332
(541) 851-1857
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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