Doctor Name: | HOLLY PIRTLE |
NPI Number: | 1205208493 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180009116 |
Business Practice Address: | 40b Edwardsville Prof Park Edwardsville, IL - 620253602 |
Business Phone Number: | 6182482040 |
Business Fax Number: | 6182482040 |
Mailing Address: | Po Box 101, EDWARDSVILLE |
State: | IL |
Postal Code: | 620250101 |
Phone Number: | 6182482040 |
Fax Number: | 6182482040 |
NPI Enumeration Date: | 10/27/2015 |
NPI Last Update Date: | 10/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180009116 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |