Provider Demographics
NPI:1417030834
Name:HOLTMEYER, WILLIAM JOSEPH JR (MS, NCC, LPC, CEAP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:HOLTMEYER
Suffix:JR
Gender:M
Credentials:MS, NCC, LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 E. SUNSHINE, SUITE 718
Mailing Address - Street 2:WILLIAM HOLTMEYER, JR.
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1369
Mailing Address - Country:US
Mailing Address - Phone:417-860-3858
Mailing Address - Fax:
Practice Address - Street 1:1736 E. SUNSHINE, SUITE 718
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1369
Practice Address - Country:US
Practice Address - Phone:417-860-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002474101YP2500X
MOCS002474101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85525OtherBLUECROSSBLUESHIELDOF NEB
MO1417030834Medicaid