Provider Demographics
NPI:1629637640
Name:ALLISON A HOLTKAMP, PSYD PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:ALLISON A HOLTKAMP, PSYD PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HOLTKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:714-914-7794
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty