Provider Demographics
NPI:1154512937
Name:HOLT, BEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:W
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-5600
Mailing Address - Fax:801-475-1621
Practice Address - Street 1:5030 HARRISON BLVD
Practice Address - Street 2:BEHAVIORAL HEALTH INSTITUTE
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4311
Practice Address - Country:US
Practice Address - Phone:801-387-5600
Practice Address - Fax:801-475-1621
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7973867-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry