Individual provider Active NPI

Reginald Wynn Holt, MA, LCPC, LPC, CADC

  • Professional Counselor
  • Maryville, IL
National Provider Identifier
1487602827
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Practice address
6201 W Main St
Suite 110
Maryville, IL 62062-6870
Phone
(616) 343-6230
Fax
(618) 343-6235
NPI assigned
May 5, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 18612 IL
Mental Health Counselor 101YM0800X IL
Professional Counselor 101YP2500X IL Primary

Addresses

Primary practice location

6201 W Main St
Suite 110
Maryville, IL 62062-6870

Mailing address

1824 Rutger St
Saint Louis, MO 63104-2944
Phone (314) 621-1334

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)
Not enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
18612ILMDAddiction (Substance Use Disorder) Counselor
180-003839ILMDMental Health Counselor
178-001063ILMDProfessional Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1487602827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 RUTGER ST",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631042944",
            "telephone_number": "314-621-1334",
            "fax_number": "618-343-6235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6201 W MAIN ST",
            "address_2": "SUITE 110",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620626870",
            "telephone_number": "616-343-6230",
            "fax_number": "618-343-6235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLT",
        "first_name": "REGINALD",
        "middle_name": "WYNN",
        "name_prefix": "Mr.",
        "credential": "MA, LCPC, LPC, CADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "18612",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.