Provider Demographics
NPI:1871757278
Name:SPOTTS, HOLLY M (PSYD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:M
Last Name:SPOTTS
Suffix:
Gender:F
Credentials:PSYD
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 506
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-0506
Mailing Address - Country:US
Mailing Address - Phone:916-705-2896
Mailing Address - Fax:
Practice Address - Street 1:1700 EUREKA RD STE 155
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7786
Practice Address - Country:US
Practice Address - Phone:916-705-2896
Practice Address - Fax:916-333-0623
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPY1062103TC1900X
CAPSY 22057103TC0700X
MS54965103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling