Provider Demographics
NPI:1629583620
Name:ELAM, HOLLEY MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:HOLLEY
Middle Name:MICHELLE
Last Name:ELAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5634 E 78TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8413
Mailing Address - Country:US
Mailing Address - Phone:432-254-9450
Mailing Address - Fax:832-626-3028
Practice Address - Street 1:5634 E 78TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8413
Practice Address - Country:US
Practice Address - Phone:432-254-9450
Practice Address - Fax:832-626-3028
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73702101YP2500X
OK0782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000000OtherNONE