Healthcare Provider Details

I. General information

NPI: 1023436979
Provider Name (Legal Business Name): JAMES HOLTZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 N GREEN BAY AVE
GLENDALE WI
53209-4446
US

IV. Provider business mailing address

5650 N GREEN BAY AVE
GLENDALE WI
53209-4446
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax: 414-921-5652
Mailing address:
  • Phone: 262-789-1191
  • Fax: 414-921-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7160
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: