Provider Demographics
NPI:1790505949
Name:HOLTAN, JARRYD JOHN (LMHCA)
Entity type:Individual
Prefix:
First Name:JARRYD
Middle Name:JOHN
Last Name:HOLTAN
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 W GARDNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1835
Mailing Address - Country:US
Mailing Address - Phone:207-838-7334
Mailing Address - Fax:
Practice Address - Street 1:1400 114TH AVE SE STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6924
Practice Address - Country:US
Practice Address - Phone:971-801-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61471065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health