1831246602 NPI number — MR. ANDREW S HOLZMAN MPS, LMFT

Table of content: MR. ANDREW S HOLZMAN MPS, LMFT (NPI 1831246602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831246602 NPI number — MR. ANDREW S HOLZMAN MPS, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLZMAN
Provider First Name:
ANDREW
Provider Middle Name:
S
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPS, LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831246602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1947 BECHTEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-457-8668
Provider Business Mailing Address Fax Number:
317-844-6430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 PRO-MED LN
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-457-8668
Provider Business Practice Location Address Fax Number:
317-844-6430
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  35001269A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000184043 . This is a "ANTHEM BLUE CROSSBLUE SH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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