Basic Information
| Provider Information | |||||||||
| NPI: | 1275906091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIST-RICHER | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481081633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346475299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4900A JACKSON ROAD | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481031876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349987380 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2015 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 21831 | MN | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 6801100367 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.