Provider Demographics
NPI:1003093709
Name:HOLDER, JASON D (EDD, LCMHC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:HOLDER
Suffix:
Gender:M
Credentials:EDD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03819-0395
Mailing Address - Country:US
Mailing Address - Phone:603-382-4661
Mailing Address - Fax:603-382-0571
Practice Address - Street 1:197 LONG POND RD.
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:NH
Practice Address - Zip Code:03819
Practice Address - Country:US
Practice Address - Phone:603-382-4661
Practice Address - Fax:603-382-0571
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009729Medicaid