Provider Demographics
NPI:1255543872
Name:HOLTHAUS, STEPHANIE M (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:HOLTHAUS
Suffix:
Gender:F
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93464-0126
Mailing Address - Country:US
Mailing Address - Phone:805-245-2916
Mailing Address - Fax:805-688-9456
Practice Address - Street 1:540 ALISAL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2637
Practice Address - Country:US
Practice Address - Phone:805-245-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical