MEDICARE: MRS. ANDREA LYNN HOLT MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2005031752	MO

General Provider Information

NPI Number	:	1437392032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA LYNN HOLT MSW, LCSW

Provider Business Mailing Address
First Line	:	4502 WREN WOOD DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3495
Country	:	US
Telephone Number	:	573-220-1717
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 WREN WOOD DR
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-3495
Country	:	US
Telephone Number	:	573-220-1717
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	04/13/2009

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