Provider Demographics
NPI:1962506063
Name:HOLDEN, WILLIAM J (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N LAURENT
Mailing Address - Street 2:STE 570
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-676-1676
Mailing Address - Fax:361-485-0510
Practice Address - Street 1:1908 N LAURENT
Practice Address - Street 2:STE 570
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-676-1676
Practice Address - Fax:361-485-0510
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24935103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00936PMedicare ID - Type Unspecified