Healthcare Provider Details

I. General information

NPI: 1104448786
Provider Name (Legal Business Name): JEAN NICOLE HOLMAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 GREEN RD
BEACHWOOD OH
44122-5705
US

IV. Provider business mailing address

1250 W 75TH ST APT 315
CLEVELAND OH
44102-2991
US

V. Phone/Fax

Practice location:
  • Phone: 216-232-5302
  • Fax:
Mailing address:
  • Phone: 330-464-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: