=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104944412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLADYS HOLMES L.M.F.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 05/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 W BRIGGSMORE AVE SUITE I
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-526-1440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 W BRIGGSMORE AVE SUITE I
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-3839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-526-1440
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC40289
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------