Provider Demographics
NPI:1730463480
Name:HOLT, WILLIAM (LPC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OLD WAGON RD
Mailing Address - Street 2:
Mailing Address - City:TIE SIDING
Mailing Address - State:WY
Mailing Address - Zip Code:82084-3029
Mailing Address - Country:US
Mailing Address - Phone:940-594-1115
Mailing Address - Fax:
Practice Address - Street 1:1771 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-8403
Practice Address - Country:US
Practice Address - Phone:307-742-3571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC - 1246101YP2500X
WYLPC-1246101Y00000X
WYPPC-546101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLPC - 1246OtherSTATE
WY546OtherSTATE LICENSE