Healthcare Provider Details

I. General information

NPI: 1003562182
Provider Name (Legal Business Name): JEFFREY HOLTHAUSEN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PINETOWN RD STE 430
FORT WASHINGTON PA
19034-2609
US

IV. Provider business mailing address

1109 CYMRY DR
BERWYN PA
19312-2056
US

V. Phone/Fax

Practice location:
  • Phone: 610-615-0531
  • Fax:
Mailing address:
  • Phone: 610-420-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013807
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: