Provider Demographics
NPI:1033432786
Name:HOLT, LONNIE JOE (MS, LMFT, CLMFT)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:JOE
Last Name:HOLT
Suffix:
Gender:M
Credentials:MS, LMFT, CLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 NE BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1835
Mailing Address - Country:US
Mailing Address - Phone:816-456-5535
Mailing Address - Fax:816-581-3731
Practice Address - Street 1:3600 NE BASSWOOD DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1835
Practice Address - Country:US
Practice Address - Phone:816-456-5535
Practice Address - Fax:816-581-3731
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010004312106H00000X
KS773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist