Provider Demographics
NPI:1114037900
Name:HOLMES, NANCY IREY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:IREY
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10824 SE OAK ST
Mailing Address - Street 2:#212
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6694
Mailing Address - Country:US
Mailing Address - Phone:503-235-2466
Mailing Address - Fax:
Practice Address - Street 1:4531 SE BELMONT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1675
Practice Address - Country:US
Practice Address - Phone:503-235-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1553103TC0700X
WA1437103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04407Medicare UPIN
ORR151757Medicare PIN
117349Medicare ID - Type Unspecified