Provider Demographics
NPI:1538560875
Name:HOLTZCLAW, JAMES GARY (LPC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GARY
Last Name:HOLTZCLAW
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-0103
Mailing Address - Country:US
Mailing Address - Phone:210-909-0222
Mailing Address - Fax:
Practice Address - Street 1:202 MEADOWVIEW LN APT D
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-3062
Practice Address - Country:US
Practice Address - Phone:210-909-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health