Provider Demographics
NPI:1033791652
Name:HOLUB, JOSEPH (MHA, LAC, CAS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HOLUB
Suffix:
Gender:M
Credentials:MHA, LAC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MANHATTAN DR STE 206
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4252
Mailing Address - Country:US
Mailing Address - Phone:720-808-2150
Mailing Address - Fax:
Practice Address - Street 1:75 MANHATTAN DR STE 206
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4252
Practice Address - Country:US
Practice Address - Phone:720-808-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0020957101YA0400X
MTBBH-LAC-LIC-72673101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1033791652Medicaid