Provider Demographics
NPI:1962896209
Name:HOLT, JUDY (MA)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1015
Mailing Address - Country:US
Mailing Address - Phone:765-282-7150
Mailing Address - Fax:765-282-9166
Practice Address - Street 1:4221 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1015
Practice Address - Country:US
Practice Address - Phone:765-282-7150
Practice Address - Fax:765-282-9166
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health