Healthcare Provider Details

I. General information

NPI: 1003093709
Provider Name (Legal Business Name): JASON D HOLDER ED.D, LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 LONG POND RD.
DANVILLE NH
03819
US

IV. Provider business mailing address

PO BOX 395
DANVILLE NH
03819-0395
US

V. Phone/Fax

Practice location:
  • Phone: 603-382-4661
  • Fax: 603-382-0571
Mailing address:
  • Phone: 603-382-4661
  • Fax: 603-382-0571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number192
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: