Healthcare Provider Details

I. General information

NPI: 1679966139
Provider Name (Legal Business Name): HEIDI HOLMES MA, LPC, BT, RLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 HICKORY AVE
HARAHAN LA
70123-4068
US

IV. Provider business mailing address

224 OAK AVE
HARAHAN LA
70123-4039
US

V. Phone/Fax

Practice location:
  • Phone: 504-313-4215
  • Fax:
Mailing address:
  • Phone: 504-450-9756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6746
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: