MEDICARE: REBECCA MICHELLE KAY HOLMSTROM LCSW

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	1041C0700X	Clinical Social Worker	67867	TX

General Provider Information

NPI Number	:	1255299038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA MICHELLE KAY HOLMSTROM LCSW

Provider Business Mailing Address
First Line	:	136 MARYLEE DR
Second Line	:
City	:	HEWITT
State	:	TX
Zip	:	76643-3731
Country	:	US
Telephone Number	:	805-748-4014
Fax Number	:	805-748-4014

Provider Business Practice Location Address
First Line	:	136 MARYLEE DR
Second Line	:
City	:	HEWITT
State	:	TX
Zip	:	76643-3731
Country	:	US
Telephone Number	:	805-748-4014
Fax Number	:	805-748-4014

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/19/2026

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