Provider Demographics
NPI:1114651155
Name:HOLT, LAUREN (CSFA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11912 BELLEGROVE RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-0242
Mailing Address - Country:US
Mailing Address - Phone:817-647-3200
Mailing Address - Fax:
Practice Address - Street 1:11912 BELLEGROVE RD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0242
Practice Address - Country:US
Practice Address - Phone:817-647-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200002OtherCSFA