Provider Demographics
NPI:1568732287
Name:HOLDER, AMY LYNN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:DORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 SCIENCE DRIVE SUITE 300
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711
Mailing Address - Country:US
Mailing Address - Phone:608-236-4460
Mailing Address - Fax:608-236-4461
Practice Address - Street 1:440 SCIENCE DRIVE SUITE 300
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:608-236-4460
Practice Address - Fax:608-236-4461
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7730-125101Y00000X, 101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor