Provider Demographics
NPI:1548056443
Name:HOLLEY, ELLIOT
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12768 S SNOW FLOWER CT
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7441
Mailing Address - Country:US
Mailing Address - Phone:602-621-9628
Mailing Address - Fax:
Practice Address - Street 1:8811 S TACOMA WAY UNIT 204206
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4595
Practice Address - Country:US
Practice Address - Phone:253-321-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician