Healthcare Provider Details

I. General information

NPI: 1174741789
Provider Name (Legal Business Name): ROBERT HOLMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 11/09/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ELK ST
RAPID CITY SD
57701-7351
US

IV. Provider business mailing address

350 ELK ST
RAPID CITY SD
57701-7351
US

V. Phone/Fax

Practice location:
  • Phone: 605-343-7262
  • Fax: 605-343-7293
Mailing address:
  • Phone: 605-343-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1250
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0003865
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerBLUE CROSS/BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: