Healthcare Provider Details

I. General information

NPI: 1952163420
Provider Name (Legal Business Name): MELINDA L HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LARCH ST FL 3
SCRANTON PA
18509-2802
US

IV. Provider business mailing address

115 BASALYGA ST # 2
JESSUP PA
18434-1108
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-5561
  • Fax:
Mailing address:
  • Phone: 272-228-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

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: