Provider Demographics
NPI:1225763204
Name:HOLUB, KRISTIN H (LPC-IT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:H
Last Name:HOLUB
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 JERRY THOMAS PKWY
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-7038
Mailing Address - Country:US
Mailing Address - Phone:608-774-5560
Mailing Address - Fax:
Practice Address - Street 1:2685 JERRY THOMAS PKWY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-7038
Practice Address - Country:US
Practice Address - Phone:608-774-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional