Provider Demographics
NPI:1750600342
Name:HOLT, ANDREA LEIGH (LMFT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:HOLT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S COLLEGE AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3071
Mailing Address - Country:US
Mailing Address - Phone:970-691-9007
Mailing Address - Fax:
Practice Address - Street 1:612 S COLLEGE AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3071
Practice Address - Country:US
Practice Address - Phone:970-691-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6684101YA0400X
CO763106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)