Provider Demographics
NPI:1275966384
Name:HOLMES, JOSHUA C
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 HERITAGE PARK BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5675
Mailing Address - Country:US
Mailing Address - Phone:801-784-0264
Mailing Address - Fax:801-682-8008
Practice Address - Street 1:880 HERITAGE PARK BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5675
Practice Address - Country:US
Practice Address - Phone:801-784-0264
Practice Address - Fax:801-682-8008
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6531111-3502101YP2500X
UT6531111-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1275966384Medicaid