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NPI Code Detail

MEDICARE: SEAN HOLMAN

MEDICARE: SEAN HOLMAN
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
1101YA0400XAddiction (Substance Use Disorder) Counselor3904NM
2101YM0800XMental Health CounselorX06328NM

General Provider Information

NPI Number : 1164458527
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEAN HOLMAN
Provider Business Mailing Address
First Line : 100 W GRIGGS AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-1234
Country : US
Telephone Number : 575-647-2869
Fax Number : 575-647-2898
Provider Business Practice Location Address
First Line : 100 W GRIGGS AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-1234
Country : US
Telephone Number : 575-647-2869
Fax Number : 575-647-2898
Authorized Official
Title or Position : HUMAN RESOURCE ASSISTANT
Name : LISA HERNANDEZ
Credential :
Telephone Number : 575-647-2876
Provider Enumeration Date : 06/25/2006
Last Update Date : 08/12/2008

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Directions to “SEAN HOLMAN ” Practice Location

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