Provider Demographics
NPI:1265451843
Name:HOLT, JEFFREY EDWARD (LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:EDWARD
Last Name:HOLT
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4312
Mailing Address - Country:US
Mailing Address - Phone:816-797-0039
Mailing Address - Fax:816-569-6530
Practice Address - Street 1:4010 WASHINGTON
Practice Address - Street 2:SUITE 505
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111
Practice Address - Country:US
Practice Address - Phone:816-797-0039
Practice Address - Fax:816-569-6530
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025351101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495025710Medicaid