MEDICARE: MELINDA DESIREE HOLMES RSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740652031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA DESIREE HOLMES RSW

Provider Business Mailing Address
First Line	:	8939 JEFFERSON HWY APT 214
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2419
Country	:	US
Telephone Number	:	504-782-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	8946 INTERLINE AVE STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-1913
Country	:	US
Telephone Number	:	225-205-1820
Fax Number	:

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

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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