Provider Demographics
NPI:1780109520
Name:HOLT, BRYAN (LLPC)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:HOLT
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 CORKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4054
Mailing Address - Country:US
Mailing Address - Phone:248-978-5434
Mailing Address - Fax:
Practice Address - Street 1:45 N LAPEER ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3159
Practice Address - Country:US
Practice Address - Phone:248-693-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016193101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588841787OtherTREESIDE