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General NPI Number Information
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NPI Number | 1780488817
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Entity Type | Organization
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Legal Business Name | HOLT THERAPY LLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 6483 CITATION DR STE B
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City | CLARKSTON
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State | MI
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Zip | 48346-2994
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Country | US
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Telephone | 248-978-5434
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Fax |
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Provider Business Mailing Address
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Address Line | 6483 CITATION DR STE B
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City | CLARKSTON
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State | MI
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Zip | 48346-2994
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Country | US
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Telephone | 248-978-5434
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICIAN
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Name | BRYAN DAVID HOLT
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Credential | LPC
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Telephone | 248-978-5434
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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 |
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License Number State |
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