Provider Demographics
NPI:1790221265
Name:HOLTE, SAMUEL JOSEPH (LMHC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:HOLTE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 DR. MLK JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3302
Mailing Address - Country:US
Mailing Address - Phone:727-773-5507
Mailing Address - Fax:
Practice Address - Street 1:1432 DR. MARTIN LUTHER KING JR ST. N
Practice Address - Street 2:
Practice Address - City:ST PETERBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3302
Practice Address - Country:US
Practice Address - Phone:727-773-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health