Provider Demographics
NPI:1932999554
Name:HOLT, THOMAS M (PPS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:HOLT
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ALDEBARAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-1208
Mailing Address - Country:US
Mailing Address - Phone:559-392-7754
Mailing Address - Fax:
Practice Address - Street 1:100 ALDEBARAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-1208
Practice Address - Country:US
Practice Address - Phone:559-392-7754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210208621101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool