Provider Demographics
NPI:1205146487
Name:HOLSTON, STEVEN GREGG (PHD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:GREGG
Last Name:HOLSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 200-171
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6797
Mailing Address - Country:US
Mailing Address - Phone:760-537-0696
Mailing Address - Fax:800-737-2082
Practice Address - Street 1:777 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 200-171
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6797
Practice Address - Country:US
Practice Address - Phone:760-537-0696
Practice Address - Fax:800-737-2082
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY13377103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist