Provider Demographics
NPI:1235455692
Name:HOLAMON, TERI (LPC, RPT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:HOLAMON
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 BERKELEY CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-7542
Mailing Address - Country:US
Mailing Address - Phone:214-315-9670
Mailing Address - Fax:
Practice Address - Street 1:707 W AVENUE D
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7001
Practice Address - Country:US
Practice Address - Phone:214-315-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional