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General NPI Number Information
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NPI Number | 1932795697
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Entity Type | Individual
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Provider Name | JESSICA MARIE HOLMES MA
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Gender | Female
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 1148 4TH ST
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City | MUSKEGON
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State | MI
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Zip | 49441-1907
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Country | US
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Telephone | 231-728-6345
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Fax |
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Provider Business Mailing Address
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Address Line | 958 BOWLINE RD APT E
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City | NORTON SHORES
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State | MI
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Zip | 49441-6179
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Country | US
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Telephone | 231-288-0378
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362009087
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License Number State | MI
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