Provider Demographics
NPI:1740336973
Name:HOLBROOK, STEPHEN A (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 S 8TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-2577
Mailing Address - Country:US
Mailing Address - Phone:641-357-0272
Mailing Address - Fax:641-357-3059
Practice Address - Street 1:518 S 8TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-2577
Practice Address - Country:US
Practice Address - Phone:642-357-0272
Practice Address - Fax:641-357-3059
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00827103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical