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General NPI Number Information
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NPI Number | 1336788678
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Entity Type | Individual
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Provider Name | MARY HOLTOM PSYCHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 4300 LONG BEACH BLVD STE 340
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City | LONG BEACH
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State | CA
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Zip | 90807-2017
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Country | US
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Telephone | 562-294-4024
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Fax |
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Provider Business Mailing Address
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Address Line | 6324 SOUTHWIND DR
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City | WHITTIER
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State | CA
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Zip | 90601-3843
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY31334
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License Number State | CA
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