Healthcare Provider Details

I. General information

NPI: 1407121171
Provider Name (Legal Business Name): ANTHONY RAY HOLMES LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 STEVE DRIVE
RUSSELL SPRINGS KY
42642-4622
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 270-866-3161
  • Fax: 270-866-3163
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1226
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: