MEDICARE: MS. RHONDA MARIE HOLDREN L.P.C.

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	101YM0800X	Mental Health Counselor	2001001603	MO

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

General Provider Information

NPI Number	:	1740308618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHONDA MARIE HOLDREN L.P.C.

Provider Business Mailing Address
First Line	:	4841 S ROSLYN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4906
Country	:	US
Telephone Number	:	417-824-0728
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 W SUNSHINE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-2236
Country	:	US
Telephone Number	:	417-862-2273
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/09/2007

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