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Individual

HOLLY ERIN BASOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
(314) 206-3708
Mailing address
1430 OLIVE ST, SUITE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
(314) 206-3708

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2014012314
MO
104100000X
Social Worker

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2014012314
LPC
MO
Enumeration date
01/25/2007
Last updated
11/29/2021
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