Basic Information
| Provider Information | |||||||||
| NPI: | 1144485103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLT | ||||||||
| FirstName: | KEREN | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 SPRUCE STREET, STE 300 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064616935 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4400 37TH AVE S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064616957 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2008 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | RC60026063 | WA | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | LW60271798 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.