Provider Demographics
NPI:1780050823
Name:HOLTSOI, ROBERT W (LAC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:HOLTSOI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 N. CENTRAL AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:602-279-5262
Mailing Address - Fax:620-279-5393
Practice Address - Street 1:4041 N. CENTRAL AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-279-5262
Practice Address - Fax:602-279-5390
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC15645101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor