Provider Demographics
NPI:1093184681
Name:HOLMSTROM, HEIDIE JO (LPC)
Entity Type:Individual
Prefix:
First Name:HEIDIE
Middle Name:JO
Last Name:HOLMSTROM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1221
Mailing Address - Country:US
Mailing Address - Phone:605-725-2155
Mailing Address - Fax:605-725-2156
Practice Address - Street 1:121 4TH AVE SW STE 1
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4133
Practice Address - Country:US
Practice Address - Phone:605-725-2155
Practice Address - Fax:605-725-2156
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7375101Y00000X
SDLPC - MH 2309101YM0800X
SDLPCMH2309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health