Healthcare Provider Details

I. General information

NPI: 1275410136
Provider Name (Legal Business Name): MARK EDWARD HOLMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA STE B5
LAGUNA HILLS CA
92653-3125
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA STE B5
LAGUNA HILLS CA
92653-3125
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-9295
  • Fax:
Mailing address:
  • Phone: 714-532-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT156181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: