Healthcare Provider Details

I. General information

NPI: 1497679237
Provider Name (Legal Business Name): SEAN MITCHELL JOSIAH HOLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 NW UNIVERSITY BLVD STE 204
PORT SAINT LUCIE FL
34986-2281
US

IV. Provider business mailing address

540 NW UNIVERSITY BLVD STE 204
PORT SAINT LUCIE FL
34986-2281
US

V. Phone/Fax

Practice location:
  • Phone: 772-494-7770
  • Fax: 772-258-4489
Mailing address:
  • Phone: 772-494-7770
  • Fax: 772-258-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27615
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: