Provider Demographics
NPI:1982611737
Name:HOLT, KARL JON (LMHC, LCAT)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:JON
Last Name:HOLT
Suffix:
Gender:M
Credentials:LMHC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 AMY LN
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-9452
Mailing Address - Country:US
Mailing Address - Phone:585-637-4141
Mailing Address - Fax:
Practice Address - Street 1:85 S UNION ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1255
Practice Address - Country:US
Practice Address - Phone:585-349-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health