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General NPI Number Information
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NPI Number | 1508418179
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Entity Type | Organization
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Legal Business Name | HOLMES IMPACT WELLNESS, LLC
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 2227 S GARNETT RD
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City | TULSA
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State | OK
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Zip | 74129-5119
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Country | US
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Telephone | 539-777-2956
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Fax |
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Provider Business Mailing Address
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Address Line | 3425 E TRENTON ST
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City | BROKEN ARROW
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State | OK
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Zip | 74014-8856
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Country | US
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Telephone | 539-777-2956
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MELINDA HOLMES
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Credential | LPC
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Telephone | 539-777-2956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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