Healthcare Provider Details

I. General information

NPI: 1225940984
Provider Name (Legal Business Name): KELLY HOLT MS, LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 MEDICAL CIR STE 201
MADISON WI
53719-1228
US

IV. Provider business mailing address

5609 MEDICAL CIR STE 201
MADISON WI
53719-1228
US

V. Phone/Fax

Practice location:
  • Phone: 608-514-1625
  • Fax: 608-398-8881
Mailing address:
  • Phone: 608-514-1625
  • Fax: 608-398-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9336-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: