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General NPI Number Information
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NPI Number | 1003562182
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Entity Type | Individual
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Provider Name | JEFFREY HOLTHAUSEN LPC
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Gender | Male
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Dates
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Enumeration Date | 02/26/2022
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Last Update Date | 02/26/2022
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Provider Practice Location Address
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Address Line | 1200 CALLOWHILL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19123-3658
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Country | US
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Telephone | 215-825-8220
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 CYMRY DR
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City | BERWYN
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State | PA
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Zip | 19312-2056
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Country | US
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Telephone | 610-420-0316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC013807
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License Number State | PA
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