Provider Demographics
NPI:1508990227
Name:HOLTKAMP, ALLISON ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:ANNE
Last Name:HOLTKAMP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17744 SKY PARK CIR STE 285
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4461
Mailing Address - Country:US
Mailing Address - Phone:714-914-7794
Mailing Address - Fax:
Practice Address - Street 1:17744 SKY PARK CIR STE 285
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4461
Practice Address - Country:US
Practice Address - Phone:714-914-7794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18001OtherPSYCHOLOGIST LICENSE