MEDICARE: MS. MARY M HOLMAN 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	101Y00000X	Counselor	18573	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6464LC	OTHER	TX	BCBS PROVIDER IDENTIFIER

General Provider Information

NPI Number	:	1619048212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY M HOLMAN LPC

Provider Business Mailing Address
First Line	:	2604 W 48TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-5602
Country	:	US
Telephone Number	:	512-585-4899
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 SPICEWOOD SPRINGS RD
Second Line	:	BLDG 4, SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78759-8598
Country	:	US
Telephone Number	:	512-231-0164
Fax Number	:	512-276-8958

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/09/2013

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