Provider Demographics
NPI:1679058267
Name:HATCH, HOLLY (LPCC)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 FAIRFIELD DR # DE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-2433
Mailing Address - Country:US
Mailing Address - Phone:915-241-0472
Mailing Address - Fax:
Practice Address - Street 1:1508 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2433
Practice Address - Country:US
Practice Address - Phone:915-241-0472
Practice Address - Fax:575-267-6228
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77335101Y00000X
00121188225C00000X
NMCTB20230089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96339332Medicaid