Provider Demographics
NPI:1255437950
Name:BLITZ, HOLLEY REILLY (MA MFT)
Entity type:Individual
Prefix:MS
First Name:HOLLEY
Middle Name:REILLY
Last Name:BLITZ
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:MRS
Other - First Name:C
Other - Middle Name:HOLLEY
Other - Last Name:BLITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA MFT
Mailing Address - Street 1:4750 NORTH MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713
Mailing Address - Country:US
Mailing Address - Phone:208-996-0932
Mailing Address - Fax:
Practice Address - Street 1:4750 N FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2715
Practice Address - Country:US
Practice Address - Phone:208-996-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33818106H00000X
IDLMFT-8097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist