Provider Demographics
NPI:1710682497
Name:HOLDER, KATHERINE MAILE (PSS, CRM, CADC-R)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MAILE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PSS, CRM, CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8444 N 90TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4437
Mailing Address - Country:US
Mailing Address - Phone:602-248-8886
Mailing Address - Fax:602-854-0504
Practice Address - Street 1:702 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2404
Practice Address - Country:US
Practice Address - Phone:503-991-5903
Practice Address - Fax:997-142-8262
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-CRM-686175T00000X
OR24-01-10991101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist