Provider Demographics
NPI:1033881255
Name:HOLT, KELSIE R (BSW)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:R
Last Name:HOLT
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E HARPERS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1204
Mailing Address - Country:US
Mailing Address - Phone:406-589-4210
Mailing Address - Fax:
Practice Address - Street 1:124 E HARPERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1204
Practice Address - Country:US
Practice Address - Phone:406-589-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker