Healthcare Provider Details

I. General information

NPI: 1447179825
Provider Name (Legal Business Name): MICHAEL LAMAR HOLDEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8572 TWIN TRAILS DR
ANTELOPE CA
95843-5009
US

IV. Provider business mailing address

8572 TWIN TRAILS DR
ANTELOPE CA
95843-5009
US

V. Phone/Fax

Practice location:
  • Phone: 279-204-4093
  • Fax:
Mailing address:
  • Phone: 279-204-4093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number178696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: