Provider Demographics
NPI:1376155846
Name:HOLMES, SHUNETTA CATINA
Entity Type:Individual
Prefix:
First Name:SHUNETTA
Middle Name:CATINA
Last Name:HOLMES
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 1:129 W LAKE MEAD PKWY STE 8
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:725-212-7444
Mailing Address - Fax:702-565-1020
Practice Address - Street 1:1640 ARVILLE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-3840
Practice Address - Country:US
Practice Address - Phone:725-212-7444
Practice Address - Fax:702-565-1020
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health