Healthcare Provider Details

I. General information

NPI: 1073996963
Provider Name (Legal Business Name): RYAN HOLMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 LIBRARY CT
OREGON CITY OR
97045-4066
US

IV. Provider business mailing address

2051 KAEN RD STE 367
OREGON CITY OR
97045-4035
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-8264
  • Fax: 503-655-8428
Mailing address:
  • Phone: 503-742-5300
  • Fax: 503-742-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

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: