Provider Demographics
NPI:1770692824
Name:HOLDER, LUCY (LCSW, LPC, LCDC, LMF)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LCSW, LPC, LCDC, LMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CHAMA DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:506 GLASCOW ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1406
Practice Address - Country:US
Practice Address - Phone:361-576-3385
Practice Address - Fax:361-573-7425
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09268101YP2500X
TXSW69T1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82848LOtherBLUECROSS/BLUESHIELD