Provider Demographics
NPI:1013219815
Name:HOLMQUIST, ALLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:
Last Name:HOLMQUIST
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5522
Mailing Address - Country:US
Mailing Address - Phone:626-483-6355
Mailing Address - Fax:
Practice Address - Street 1:248 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5522
Practice Address - Country:US
Practice Address - Phone:626-483-6355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 7718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist