MEDICARE: AMBER HOLT MSW, LICSW

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	101YM0800X	Mental Health Counselor	LW 60635493	WA
2	1041C0700X	Clinical Social Worker	LW 60635493	WA

General Provider Information

NPI Number	:	1588703375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER HOLT MSW, LICSW

Provider Business Mailing Address
First Line	:	7901 SKANSIE AVE STE 240
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8349
Country	:	US
Telephone Number	:	360-218-4333
Fax Number	:	253-363-9168

Provider Business Practice Location Address
First Line	:	7901 SKANSIE AVE STE 240
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-8349
Country	:	US
Telephone Number	:	360-218-4333
Fax Number	:	253-363-9168

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	10/08/2020

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