Provider Demographics
NPI:1811025901
Name:HOLT, MARLA J (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:J
Last Name:HOLT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4276 PEPPERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1534
Mailing Address - Country:US
Mailing Address - Phone:562-310-5738
Mailing Address - Fax:562-595-4100
Practice Address - Street 1:3815 ATLANTIC AVE STE 1
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-310-5738
Practice Address - Fax:562-595-4122
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT42698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist