Healthcare Provider Details

I. General information

NPI: 1518331396
Provider Name (Legal Business Name): JANNA HOLMES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 24TH ST
PUEBLO CO
81003-1411
US

IV. Provider business mailing address

1737 N SILVER OAK LN
PUEBLO WEST CO
81007-1231
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-4729
  • Fax:
Mailing address:
  • Phone: 479-979-7562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0005712
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: