Provider Demographics
NPI:1396863635
Name:HOLTHAUS, JEAN MARIE (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:HOLTHAUS
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SW GAGE BLVD
Mailing Address - Street 2:BLDG 273
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66622-0001
Mailing Address - Country:US
Mailing Address - Phone:785-350-3111
Mailing Address - Fax:785-266-3833
Practice Address - Street 1:2209 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1908
Practice Address - Country:US
Practice Address - Phone:785-266-8666
Practice Address - Fax:785-266-3833
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1975101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069775Medicare UPIN
KS068997Medicare ID - Type UnspecifiedLSCSW