Healthcare Provider Details

I. General information

NPI: 1245575257
Provider Name (Legal Business Name): DAWN JENEANE HOLMES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST SUITE 5125
TULSA OK
74137-4250
US

IV. Provider business mailing address

1358 E 58TH ST
TULSA OK
74105-8501
US

V. Phone/Fax

Practice location:
  • Phone: 918-729-7006
  • Fax: 800-260-7966
Mailing address:
  • Phone: 254-275-8210
  • Fax: 800-260-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberBHRS CERTIFIED
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: