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General NPI Number Information
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NPI Number | 1154939502
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Entity Type | Individual
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Provider Name | MADISON KENDRA HOLM , LMHC, LSAA
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Gender | Female
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 110 E MESCALERO RD
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City | ROSWELL
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State | NM
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Zip | 88201-6542
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Country | US
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Telephone | 575-755-2272
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Fax | 575-623-3325
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Provider Business Mailing Address
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Address Line | 110 E MESCALERO RD
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City | ROSWELL
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State | NM
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Zip | 88201-6542
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Country | US
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Telephone | 575-755-2272
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Fax | 575-623-3325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CTB-2024-0640
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CTB-2024-0587
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License Number State | NM
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