Individual provider Active NPI

Katherine G Holtzclaw, LMFT

  • Marriage & Family Therapist
  • Macon, GA
National Provider Identifier
1659410801
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
000861 Issued in GA
Practice address
277 Pierce Ave
Macon, GA 31204-2419
Phone
(478) 755-0060
Fax
(478) 743-3508
NPI assigned
Feb 5, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 000861 GA Primary

Addresses

Primary practice location

277 Pierce Ave
Macon, GA 31204-2419

Mailing address

277 Pierce Ave
Macon, GA 31204-2419
Phone (478) 755-0060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240402002561 GA Practitioner - Marriage and Family Therapist 4082052618 Practice locations: Gray, GA

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

183 W Clinton St
Gray, GA 31032-5307
Phone (478) 405-5880

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ingleside Counseling Resources Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1659410801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 PIERCE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312042419",
            "telephone_number": "478-755-0060",
            "fax_number": "478-743-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 PIERCE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312042419",
            "telephone_number": "478-755-0060",
            "fax_number": "478-743-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTZCLAW",
        "first_name": "KATHERINE",
        "middle_name": "G",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "000861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.