Provider Demographics
NPI:1336341247
Name:HOLT, REBECCA RODDEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RODDEY
Last Name:HOLT
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 1:3240 LA AVENIDA DE SAN MARCOS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0451
Mailing Address - Country:US
Mailing Address - Phone:505-473-7774
Mailing Address - Fax:
Practice Address - Street 1:3240 LA AVENIDA DE SAN MARCOS
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-0451
Practice Address - Country:US
Practice Address - Phone:505-473-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical