MEDICARE: JENNIFER CAMILLE HOLCOMB PHD, LMFT, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	61855	TX
2	106H00000X	Marriage & Family Therapist	201061	TX
3	106H00000X	Marriage & Family Therapist	969	CO
4	101YP2500X	Professional Counselor	6444	CO
5	103K00000X	Behavior Analyst	1-16-22431	CO

General Provider Information

NPI Number	:	1356586721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CAMILLE HOLCOMB PHD, LMFT, LPC

Provider Business Mailing Address
First Line	:	1935 DOMINION WAY STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1464
Country	:	US
Telephone Number	:	970-372-7191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 DOMINION WAY STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1464
Country	:	US
Telephone Number	:	970-372-7191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	07/25/2016

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