Provider Demographics
NPI:1871101717
Name:PETERSON-HOLT, NANCY KAY (LMFT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KAY
Last Name:PETERSON-HOLT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-521 KAPALAI RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2903
Mailing Address - Country:US
Mailing Address - Phone:808-366-1947
Mailing Address - Fax:
Practice Address - Street 1:45-521 KAPALAI RD
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2903
Practice Address - Country:US
Practice Address - Phone:808-366-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT34388106H00000X
HIMFT683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist