Active NPI
Casey A Holtz, PHD
- Clinical Psychologist
- Brookfield, WI
National Provider Identifier
1295040988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2962-57
- Practice address
- 17100 W North Ave
Suite 100
Brookfield, WI 53005-4436 - Phone
- (262) 786-9184
- Fax
- (262) 786-1906
- NPI assigned
- Aug 18, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4444-125 | WI | |
| Mental Health Counselor | 101YM0800X | 594-226 | WI | |
| Clinical Psychologist | 103TC0700X | 2962-57 | WI | Primary |
Addresses
Primary practice location
17100 W North Ave
Suite 100
Brookfield, WI 53005-4436
Mailing address
17100 W North Ave
Suite 100
Brookfield, WI 53005-4436
Phone (414) 810-7647
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 594-226 | WI | MD | Mental Health Counselor |
| 4444-125 | WI | MD | Professional Counselor |
| 2962-57 | WI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christian Counseling Associates LLC | Mental Health | Past | Accepting new patients |
| Anne Huebner & Associates LLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365552000000",
"number": "1295040988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17100 W NORTH AVE",
"address_2": "SUITE 100",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530054436",
"telephone_number": "414-810-7647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17100 W NORTH AVE",
"address_2": "SUITE 100",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530054436",
"telephone_number": "262-786-9184",
"fax_number": "262-786-1906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLTZ",
"first_name": "CASEY",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-18",
"last_updated": "2013-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WI",
"license": "4444-125",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "594-226",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WI",
"license": "2962-57",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.