Provider Demographics
NPI:1114018876
Name:GHOLSON, PRICE HAROLD (PSYD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:PRICE
Middle Name:HAROLD
Last Name:GHOLSON
Suffix:
Gender:M
Credentials:PSYD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 NORTH BYP
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1345
Mailing Address - Country:US
Mailing Address - Phone:573-888-4447
Mailing Address - Fax:537-888-2999
Practice Address - Street 1:822 NORTH BYP
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-1345
Practice Address - Country:US
Practice Address - Phone:573-888-4447
Practice Address - Fax:537-888-2999
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO53979101Y00000X
MO002707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO122050OtherBLUE CROSS/BLUE SHIELD MO
MO11470514OtherCAQH-UNIV CRED DATA SOURC