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General NPI Number Information
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NPI Number | 1316748783
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Entity Type | Individual
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Provider Name | DENEEN AMANDA HOLMES MA LPC NCC ALMFT LPN
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Gender | Female
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 19624 GOVERNORS HWY
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2092
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Country | US
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Telephone | 872-225-6010
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 179TH ST
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-2918
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Country | US
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Telephone | 708-833-9298
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 208.001188
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043.116761
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.019884
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License Number State | IL
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