Provider Demographics
NPI:1265510283
Name:HOLMES, DEBORAH ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:HOLMES
Suffix:
Gender:F
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:PO BOX 450916
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-0916
Mailing Address - Country:US
Mailing Address - Phone:918-791-3610
Mailing Address - Fax:918-791-3612
Practice Address - Street 1:1107 E 13TH ST STE E
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7956
Practice Address - Country:US
Practice Address - Phone:918-791-3610
Practice Address - Fax:918-791-3612
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK692103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100653390DMedicaid
OKP00078504OtherRAILROAD MEDICARE
R42021Medicare UPIN
OK231324101Medicare PIN