Provider Demographics
NPI:1750880811
Name:SAMUEL HOLTE COUNSELING
Entity type:Organization
Organization Name:SAMUEL HOLTE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:727-773-5507
Mailing Address - Street 1:2715 MIRIAM ST S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33711-3717
Mailing Address - Country:US
Mailing Address - Phone:727-773-5507
Mailing Address - Fax:
Practice Address - Street 1:1432 MARTIN LUTHER KING ST N # JRN
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3302
Practice Address - Country:US
Practice Address - Phone:727-821-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14145261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health