Provider Demographics
NPI:1255992384
Name:HOLLEY, LEE (PRSS)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 PIN OAK PARK APT 4102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2299
Mailing Address - Country:US
Mailing Address - Phone:512-938-2472
Mailing Address - Fax:
Practice Address - Street 1:6912 STELLA LINK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1171
Practice Address - Country:US
Practice Address - Phone:512-938-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1616-0617101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)