Provider Demographics
NPI:1871278507
Name:HOLLAWAY, BRANDY R
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:R
Last Name:HOLLAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:SUNRAY
Mailing Address - State:TX
Mailing Address - Zip Code:79086-0354
Mailing Address - Country:US
Mailing Address - Phone:806-922-3785
Mailing Address - Fax:
Practice Address - Street 1:814 AVENUE P
Practice Address - Street 2:
Practice Address - City:SUNRAY
Practice Address - State:TX
Practice Address - Zip Code:79086-2504
Practice Address - Country:US
Practice Address - Phone:806-922-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health