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General NPI Number Information
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NPI Number | 1396931630
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Entity Type | Individual
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Provider Name | MADGE CLARE HOLMES PHD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 4157 ZURICH DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7524
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Country | US
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Telephone | 719-282-6248
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Fax | 719-282-6249
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Provider Business Mailing Address
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Address Line | 4157 ZURICH DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7524
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Country | US
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Telephone | 719-282-6248
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Fax | 719-282-6249
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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 | 25576
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 164515
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 855
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License Number State | CO
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