Provider Demographics
NPI:1720330939
Name:HOLDER, MICHAEL (MHPP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HOLDER
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 TURMAN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8998
Mailing Address - Country:US
Mailing Address - Phone:870-268-8875
Mailing Address - Fax:870-268-8695
Practice Address - Street 1:3009 TURMAN DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8998
Practice Address - Country:US
Practice Address - Phone:870-268-8875
Practice Address - Fax:870-268-8695
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator