Provider Demographics
NPI:1073518775
Name:HOLT, JULIE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:A
Last Name:HOLT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTSIDE DR NW
Mailing Address - Street 2:STE 309
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3699
Mailing Address - Country:US
Mailing Address - Phone:423-728-2282
Mailing Address - Fax:423-728-2234
Practice Address - Street 1:2700 WESTSIDE DR NW
Practice Address - Street 2:STE 309
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3699
Practice Address - Country:US
Practice Address - Phone:423-728-2282
Practice Address - Fax:423-728-2234
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3695698Medicaid
TN109278OtherBLUE CROSS BLUE SHIELD
TN3695698Medicaid