Provider Demographics
NPI:1295383990
Name:HOLDER, AKEEMIA LORENE
Entity Type:Individual
Prefix:
First Name:AKEEMIA
Middle Name:LORENE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 SW 27TH ST APT 308
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7954
Mailing Address - Country:US
Mailing Address - Phone:580-647-1021
Mailing Address - Fax:
Practice Address - Street 1:YOUTH CARE OF OKLAHOMA
Practice Address - Street 2:
Practice Address - City:713 SW C AVENUE
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator