Provider Demographics
NPI:1558051748
Name:HOLTAN, DAWN CYBELLE FRANK (CA BBS AMFT #134282)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:CYBELLE FRANK
Last Name:HOLTAN
Suffix:
Gender:F
Credentials:CA BBS AMFT #134282
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:CYBELLE
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2930 DOMINGO AVE # 1268
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2454
Mailing Address - Country:US
Mailing Address - Phone:415-326-3439
Mailing Address - Fax:
Practice Address - Street 1:2311 LOVERIDGE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5117
Practice Address - Country:US
Practice Address - Phone:888-678-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134282106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist