Provider Demographics
NPI:1922760487
Name:HOLTER, ALEXANDRIA RAE BRIDGES
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:RAE BRIDGES
Last Name:HOLTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:HOLTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:900 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3428
Mailing Address - Country:US
Mailing Address - Phone:406-443-7151
Mailing Address - Fax:
Practice Address - Street 1:900 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3428
Practice Address - Country:US
Practice Address - Phone:406-443-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional