Provider Demographics
NPI:1295936151
Name:ANGELA N. HOLOUBEK, LSCSW
Entity type:Organization
Organization Name:ANGELA N. HOLOUBEK, LSCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:HOLOUBEK
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-804-5135
Mailing Address - Street 1:313 N SENECA ST
Mailing Address - Street 2:#117
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5937
Mailing Address - Country:US
Mailing Address - Phone:316-804-5135
Mailing Address - Fax:888-393-8364
Practice Address - Street 1:313 N SENECA ST
Practice Address - Street 2:#117
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5937
Practice Address - Country:US
Practice Address - Phone:316-804-5135
Practice Address - Fax:888-393-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200438180Medicaid