Provider Demographics
NPI:1295011096
Name:HOLMES, KARISSA MICHELLE (QMHA)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:MICHELLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14355 SW ALLEN BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4741
Mailing Address - Country:US
Mailing Address - Phone:503-828-3402
Mailing Address - Fax:503-828-3401
Practice Address - Street 1:14355 SW ALLEN BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4741
Practice Address - Country:US
Practice Address - Phone:503-828-3402
Practice Address - Fax:503-828-3401
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500708243Medicaid