Provider Demographics
NPI:1386095354
Name:HOLTROP, CONNIE JOY (LCSW)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:JOY
Last Name:HOLTROP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:JOY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:12303 DE PAUL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2512
Mailing Address - Country:US
Mailing Address - Phone:314-344-7968
Mailing Address - Fax:314-344-7736
Practice Address - Street 1:12303 DE PAUL DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2512
Practice Address - Country:US
Practice Address - Phone:314-344-7968
Practice Address - Fax:314-344-7736
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0051281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical