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NPI Code Detail

MEDICARE: TIM HOLT

MEDICARE: TIM HOLT
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
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1598608291
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIM HOLT
Provider Business Mailing Address
First Line : 5220 W INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85031-2605
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5220 W INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85031-2605
Country : US
Telephone Number : 623-691-4085
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2026
Last Update Date : 04/09/2026

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Directions to “ TIM HOLT ” Practice Location

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