Provider Demographics
NPI:1982019741
Name:HOLT, MELANIE (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 CHURCHHILL DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-6825
Mailing Address - Country:US
Mailing Address - Phone:801-718-9840
Mailing Address - Fax:
Practice Address - Street 1:835 CHURCHHILL DOWNS DR
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-6825
Practice Address - Country:US
Practice Address - Phone:801-718-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8158804-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health