Provider Demographics
NPI:1104832229
Name:HOLBERT, JOHN M (LCSW, LSOTP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:HOLBERT
Suffix:
Gender:M
Credentials:LCSW, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 ROUND ROCK AVE
Mailing Address - Street 2:SUITE 107A
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4511
Mailing Address - Country:US
Mailing Address - Phone:512-255-2415
Mailing Address - Fax:512-255-2212
Practice Address - Street 1:1100 ROUND ROCK AVE
Practice Address - Street 2:SUITE 107A
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4511
Practice Address - Country:US
Practice Address - Phone:512-255-2415
Practice Address - Fax:512-255-2212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX050841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical