Provider Demographics
NPI:1477756641
Name:HOLT, MARY BETH (PHD LISWS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:HOLT
Suffix:
Gender:F
Credentials:PHD LISWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 OAKLAND PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3555
Mailing Address - Country:US
Mailing Address - Phone:614-252-0731
Mailing Address - Fax:614-252-8468
Practice Address - Street 1:4653 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-3298
Practice Address - Country:US
Practice Address - Phone:614-252-0731
Practice Address - Fax:614-252-8468
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0009950104100000X
OHI.99501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker