Provider Demographics
NPI:1538179932
Name:HOLLEY, KATHARINE ROBINETT
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ROBINETT
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 FAIRWAY DR STE 208
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5810
Mailing Address - Country:US
Mailing Address - Phone:406-581-9050
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRWAY DR STE 208
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5810
Practice Address - Country:US
Practice Address - Phone:406-581-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000744813OtherBCBS PRE-LICENSED PROF
MT0255374Medicaid