Provider Demographics
NPI:1679728562
Name:HOLDEN, ROBERT EDWARD (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:LPC, 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 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2214
Mailing Address - Country:US
Mailing Address - Phone:417-434-4663
Mailing Address - Fax:
Practice Address - Street 1:902 E 4TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2214
Practice Address - Country:US
Practice Address - Phone:417-434-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009250101YP2500X
MO2006013051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional