Provider Demographics
NPI:1154771889
Name:FANCHER, HOLLY LORRAINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:LORRAINE
Last Name:FANCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 HUGHES RD
Mailing Address - Street 2:375
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7366
Mailing Address - Country:US
Mailing Address - Phone:573-259-7355
Mailing Address - Fax:
Practice Address - Street 1:1452 HUGHES RD
Practice Address - Street 2:SUITE 375
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7366
Practice Address - Country:US
Practice Address - Phone:573-259-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX545861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical