Provider Demographics
NPI:1831110485
Name:HOLTKAMP, KAROLE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:KAROLE
Middle Name:
Last Name:HOLTKAMP
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 N 22ND DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2705
Mailing Address - Country:US
Mailing Address - Phone:602-818-8888
Mailing Address - Fax:602-795-1975
Practice Address - Street 1:2400 E ARIZONA BILTMORE CIR
Practice Address - Street 2:BDLG 4, SUITE 2430
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2107
Practice Address - Country:US
Practice Address - Phone:602-818-0711
Practice Address - Fax:602-795-1975
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860795627 0004Medicare UPIN
AZ3289607Medicare UPIN
AZ936429Medicare UPIN
AZ464986Medicare UPIN