Provider Demographics
NPI:1033232707
Name:HOLT, LUTHER (LADC)
Entity Type:Individual
Prefix:MR
First Name:LUTHER
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7575 GOLDEN VALLEY RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4562
Mailing Address - Country:US
Mailing Address - Phone:763-525-8590
Mailing Address - Fax:763-525-8592
Practice Address - Street 1:7575 GOLDEN VALLEY RD
Practice Address - Street 2:SUITE 230
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4562
Practice Address - Country:US
Practice Address - Phone:763-525-8590
Practice Address - Fax:763-525-8592
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301175101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)