Healthcare Provider Details

I. General information

NPI: 1689071763
Provider Name (Legal Business Name): HOLT PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ARAPAHOE AVE SUITE 12
BOULDER CO
80302-5854
US

IV. Provider business mailing address

100 ARAPAHOE AVE SUITE 12
BOULDER CO
80302-5854
US

V. Phone/Fax

Practice location:
  • Phone: 720-663-1366
  • Fax:
Mailing address:
  • Phone: 720-663-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number12076
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SARAH HOLT
Title or Position: PSYCHOTHERAPIST
Credential: MA, LPC, NCC
Phone: 303-809-7431