Nicole C Holder, MS, LPC-IT – Mental Health Counselor

Key facts

NPI: 1619698545
Entity type: Individual (NPI type 1)
Primary specialty: Mental Health Counselor 101YM0800X
License: 7101 (WI)
Practice address: 1221 Innovation Dr Ste 221
Whitewater, WI 53190-1483
Phone: (262) 473-0670
Fax: (608) 268-9780
NPI assigned: Sep 8, 2022
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Community Service Associates, SC Mental Health Clinic/Center (Including Community Mental Health Center) · Portage, WI · NPI 1780610923

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Master of Science

State licenses

License	State	Type	Specialty
7101	WI	MD	Certified Registered Nurse Anesthetist

Practice roles

Organization	Specialty	Status	New patients
Community Service Associates, SC		Past since Sep 11, 2022	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Mental Health Counselor	101YM0800X	7101	WI	Yes

Addresses

Primary practice location

1221 Innovation Dr Ste 221
Whitewater, WI 53190-1483

Mailing address

PO Box 301
Portage, WI 53901-0301
Phone (608) 742-5518

Other providers in Whitewater, WI

All providers in Whitewater, WI · Mental Health Counselor in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.