Healthcare Provider Details

I. General information

NPI: 1669376927
Provider Name (Legal Business Name): REBEKAH HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3715 E OVERLAND RD STE 100
MERIDIAN ID
83642-8305
US

IV. Provider business mailing address

4438 S SKYRIDGE WAY
BOISE ID
83709-5184
US

V. Phone/Fax

Practice location:
  • Phone: 208-866-7059
  • Fax:
Mailing address:
  • Phone: 503-806-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3581738
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: