Healthcare Provider Details

I. General information

NPI: 1316748783
Provider Name (Legal Business Name): DENEEN AMANDA HOLMES MA LPC NCC ALMFT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19624 GOVERNORS HWY
FLOSSMOOR IL
60422-2092
US

IV. Provider business mailing address

4820 179TH ST
COUNTRY CLUB HILLS IL
60478-2918
US

V. Phone/Fax

Practice location:
  • Phone: 872-225-6010
  • Fax:
Mailing address:
  • Phone: 708-833-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.019884
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.001188
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043.116761
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: