Provider Demographics
NPI:1679966139
Name:HOLMES, HEIDI (MA, LPC, BT, RLT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MA, LPC, BT, RLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-4039
Mailing Address - Country:US
Mailing Address - Phone:504-450-9756
Mailing Address - Fax:
Practice Address - Street 1:190 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-4068
Practice Address - Country:US
Practice Address - Phone:504-313-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
LA6746101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician