Provider Demographics
NPI:1114596921
Name:HOLSTEAD CONSULTING SERVICES
Entity Type:Organization
Organization Name:HOLSTEAD CONSULTING SERVICES
Other - Org Name:HOLSTEAD OUTPATIENT PSYCH EVALUATION (HOPE) & COUNSELING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-544-2780
Mailing Address - Street 1:1050 CIRCLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 CIRCLE DR STE B
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5569
Practice Address - Country:US
Practice Address - Phone:920-393-7971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty