MEDICARE: DR. DEBORAH ANN HOLMES PH.D.

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	103TC1900X	Counseling Psychologist	692	OK
2	103T00000X	Psychologist	692	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00078504	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265510283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH ANN HOLMES PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 450916
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74345-0916
Country	:	US
Telephone Number	:	918-791-3610
Fax Number	:	918-791-3612

Provider Business Practice Location Address
First Line	:	1107 E 13TH ST STE E
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-7956
Country	:	US
Telephone Number	:	918-791-3610
Fax Number	:	918-791-3612

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/13/2020

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