Provider Demographics
NPI:1598902595
Name:HOLDEN, KENNETH J (EDD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MERCURY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77013-5217
Mailing Address - Country:US
Mailing Address - Phone:713-675-1118
Mailing Address - Fax:
Practice Address - Street 1:520 MERCURY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77013-5217
Practice Address - Country:US
Practice Address - Phone:713-675-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8486101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX76-0637985Medicaid