| Doctor Name: | MS. HOLLY WAGGONER |
| NPI Number: | 1639312747 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY ASSOCIATE |
| License Number: | 2008-111 |
| Business Practice Address: | 1060 Grand Avenue Beattyville, KY - 41311 |
| Business Phone Number: | 6064643212 |
| Business Fax Number: | 6064365797 |
| Mailing Address: | 115 Rockwood Ln, HAZARD |
| State: | KY |
| Postal Code: | 417019415 |
| Phone Number: | 6064365761 |
| Fax Number: | 6064365797 |
| NPI Enumeration Date: | 04/20/2009 |
| NPI Last Update Date: | 04/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2008-111 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |