Healthcare Provider Details

I. General information

NPI: 1417162033
Provider Name (Legal Business Name): SHELIA ANNETTE HOLMES BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WICKERSHAM ST
MANGUM OK
73554-9117
US

IV. Provider business mailing address

121 MEADOW PL
HOBART OK
73651-1424
US

V. Phone/Fax

Practice location:
  • Phone: 580-782-3337
  • Fax: 580-782-3338
Mailing address:
  • Phone: 580-726-3176
  • Fax: 580-782-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: