Provider Demographics
NPI:1093152332
Name:HOLMAN, KATIE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CASTLE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4465
Mailing Address - Country:US
Mailing Address - Phone:314-852-9319
Mailing Address - Fax:
Practice Address - Street 1:108 N CLAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4265
Practice Address - Country:US
Practice Address - Phone:314-422-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2013004022101YP2500X
MO2013004022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional