Provider Demographics
NPI:1588898001
Name:HOLYOAK, ROGER D (LCPC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:HOLYOAK
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 GARRETT WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5100
Mailing Address - Country:US
Mailing Address - Phone:208-233-7832
Mailing Address - Fax:208-233-7835
Practice Address - Street 1:2055 GARRETT WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5100
Practice Address - Country:US
Practice Address - Phone:208-233-7832
Practice Address - Fax:208-233-7835
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health