Provider Demographics
NPI:1174795140
Name:BOSIER, HOLLY C (LCPC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:C
Last Name:BOSIER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3793
Mailing Address - Country:US
Mailing Address - Phone:708-205-0084
Mailing Address - Fax:
Practice Address - Street 1:1590 S MILWAUKEE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3793
Practice Address - Country:US
Practice Address - Phone:708-205-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1346345824OtherTYPE 2 I AM INCORPORATED