MEDICARE: MS. JULIE A HOLT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	737	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	109278	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073518775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE A HOLT LCSW

Provider Business Mailing Address
First Line	:	2700 WESTSIDE DR NW
Second Line	:	STE 309
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3699
Country	:	US
Telephone Number	:	423-728-2282
Fax Number	:	423-728-2234

Provider Business Practice Location Address
First Line	:	2700 WESTSIDE DR NW
Second Line	:	STE 309
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3699
Country	:	US
Telephone Number	:	423-728-2282
Fax Number	:	423-728-2234

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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