Healthcare Provider Details

I. General information

NPI: 1700259025
Provider Name (Legal Business Name): ESSIE HOLT ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CENTENARY BLVD BUILDING 3 STE 312
SHREVEPORT LA
71104-3356
US

IV. Provider business mailing address

2620 CENTENARY BLVD BUILDING 3 STE 312
SHREVEPORT LA
71104-3356
US

V. Phone/Fax

Practice location:
  • Phone: 318-681-9935
  • Fax: 318-681-9938
Mailing address:
  • Phone: 318-681-9935
  • Fax: 318-681-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3141
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: