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General NPI Number Information
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NPI Number | 1710304662
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Entity Type | Individual
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Provider Name | JORDAN NICHOLE HOLTBY M.ED., ATR, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 23415 ROSEDALE RD
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City | WAYNESVILLE
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State | MO
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Zip | 65583-2752
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Country | US
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Telephone | 870-688-6185
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Fax |
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Provider Business Mailing Address
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Address Line | 23415 ROSEDALE RD
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City | WAYNESVILLE
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State | MO
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Zip | 65583-2752
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Country | US
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Telephone | 870-688-6185
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2022035130
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License Number State | MO
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