Provider Demographics
NPI:1689555112
Name:HOLT, MARK RUSSELL (MS, LMFT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:RUSSELL
Last Name:HOLT
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 C M FAGAN DR STE C
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6043
Mailing Address - Country:US
Mailing Address - Phone:985-981-5954
Mailing Address - Fax:
Practice Address - Street 1:902 C M FAGAN DR STE C
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-6043
Practice Address - Country:US
Practice Address - Phone:985-981-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203593106H00000X
LAMFT1513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist