1295936151 NPI number — ANGELA N. HOLOUBEK, LSCSW

Table of content: (NPI 1295936151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295936151 NPI number — ANGELA N. HOLOUBEK, LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELA N. HOLOUBEK, LSCSW
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1295936151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
313 N SENECA ST
Provider Second Line Business Mailing Address:
#117
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67203-5937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-804-5135
Provider Business Mailing Address Fax Number:
888-393-8364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 N SENECA ST
Provider Second Line Business Practice Location Address:
#117
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67203-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-804-5135
Provider Business Practice Location Address Fax Number:
888-393-8364
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLOUBEK
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
NICHOLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
316-804-5135

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2485 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200438180 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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