Provider Demographics
NPI:1184695496
Name:HOLCZER, GINGER A (PSYD)
Entity type:Individual
Prefix:DR
First Name:GINGER
Middle Name:A
Last Name:HOLCZER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 E BRADFORD PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6566
Mailing Address - Country:US
Mailing Address - Phone:417-890-1211
Mailing Address - Fax:417-890-1271
Practice Address - Street 1:1531 E BRADFORD PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6566
Practice Address - Country:US
Practice Address - Phone:417-890-1211
Practice Address - Fax:417-890-1271
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004033759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495982316Medicaid
000021975Medicare UPIN
MO219754578Medicare ID - Type Unspecified