Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003326489 |
---|---|
Provider Name | Michael David Holt |
First Address | Grants Pass, OR 97527-5500 |
Second Address | Medford, OR 97504-7499 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2017 |
Last Update Date | 11/10/2017 |