MEDICARE: KARA HOLMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	83455	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83455	OTHER	TX	LPC LICENSE

General Provider Information

NPI Number	:	1093387839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA HOLMES

Provider Business Mailing Address
First Line	:	3001 W 5TH ST STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-8907
Country	:	US
Telephone Number	:	972-360-8017
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 W 5TH ST STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-8907
Country	:	US
Telephone Number	:	972-360-8017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	07/12/2021

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Directions to “ KARA HOLMES ” Practice Location

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