Healthcare Provider Details

I. General information

NPI: 1619329141
Provider Name (Legal Business Name): COLISHA HOLMES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23495 MANGO DR
DENHAM SPRINGS LA
70726-7361
US

IV. Provider business mailing address

6554 FLORIDA BLVD STE 110
BATON ROUGE LA
70806-4474
US

V. Phone/Fax

Practice location:
  • Phone: 985-294-1924
  • Fax:
Mailing address:
  • Phone: 985-294-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5481
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number82930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: