Provider Demographics
NPI:1750677654
Name:HOLSWADE, JOHANNA (LPC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:HOLSWADE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9420 ENSLEY LN
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2021
Mailing Address - Country:US
Mailing Address - Phone:913-907-7911
Mailing Address - Fax:913-221-0152
Practice Address - Street 1:411 NICHOLS RD
Practice Address - Street 2:SUITE 217
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2000
Practice Address - Country:US
Practice Address - Phone:913-907-7911
Practice Address - Fax:913-221-0152
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011008766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional