MEDICARE: HOLM PSYCHOLOGICAL SERVICES LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1184330623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLM PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1585 THOMAS CENTER DR STE 106
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-3007
Country	:	US
Telephone Number	:	612-405-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 THOMAS CENTER DR STE 106
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-3007
Country	:	US
Telephone Number	:	612-405-8409
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ LICENSED PSYCHOLOGIST
Name	:	DR. LINDSEY ANN HOLM
Credential	:	PSYD, LP
Telephone Number	:	612-405-8409

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	01/27/2023

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