MEDICARE: SALLIE HOLMES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.002808	CO

General Provider Information

NPI Number	:	1881574135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLIE HOLMES

Provider Business Mailing Address
First Line	:	PO BOX 453
Second Line	:
City	:	OAK CREEK
State	:	CO
Zip	:	80467-0453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 E MAIN ST STE C
Second Line	:
City	:	OAK CREEK
State	:	CO
Zip	:	80467-5086
Country	:	US
Telephone Number	:	970-367-7094
Fax Number	:

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

Provider Enumeration Date	:	09/06/2025
Last Update Date	:	09/06/2025

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Directions to “ SALLIE HOLMES ” Practice Location

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