Provider Demographics
NPI:1962591248
Name:HOLTZMAN, MARCOS P (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:P
Last Name:HOLTZMAN
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 CALLE ANACUA
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7306
Mailing Address - Country:US
Mailing Address - Phone:956-544-7945
Mailing Address - Fax:
Practice Address - Street 1:104 CALLE ANACUA
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7306
Practice Address - Country:US
Practice Address - Phone:956-544-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10199148OtherMUTUAL OF OMAHA