Provider Demographics
NPI:1477883205
Name:HOLTGREWE, THOMAS DEAN (LCPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DEAN
Last Name:HOLTGREWE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 DEARBORN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3362
Mailing Address - Country:US
Mailing Address - Phone:913-645-6652
Mailing Address - Fax:913-362-6410
Practice Address - Street 1:5960 DEARBORN ST STE 1
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3362
Practice Address - Country:US
Practice Address - Phone:913-645-6652
Practice Address - Fax:913-362-6410
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS309101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA880171OtherBLUE CROSS BLUE SHIELD KANSAS CITY MISSOURI