Healthcare Provider Details

I. General information

NPI: 1235385337
Provider Name (Legal Business Name): ROBIN HELENE HOLMES-SULLIVAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROBIN HELENE HOLMES PH.D.

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W BROADWAY
EUGENE OR
97401-2826
US

IV. Provider business mailing address

1375 W 40TH AVE
EUGENE OR
97405-2091
US

V. Phone/Fax

Practice location:
  • Phone: 541-346-1129
  • Fax:
Mailing address:
  • Phone: 541-485-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1263
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: