Healthcare Provider Details

I. General information

NPI: 1548267719
Provider Name (Legal Business Name): PETER F HOLMES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S PROVIDENCE RD SUITE 204
COLUMBIA MO
65203-3622
US

IV. Provider business mailing address

5316 GODAS CIR
COLUMBIA MO
65202-2980
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-0077
  • Fax:
Mailing address:
  • Phone: 573-814-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2000166307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: