Provider Demographics
NPI:1417070418
Name:HOLMES, NANCY L (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 LAKE TAHOE BLVD
Mailing Address - Street 2:SUITE 27
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7728
Mailing Address - Country:US
Mailing Address - Phone:530-543-6755
Mailing Address - Fax:530-544-7128
Practice Address - Street 1:2489 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE 27
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7728
Practice Address - Country:US
Practice Address - Phone:530-543-6755
Practice Address - Fax:530-544-7128
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21338OtherPSYCHIATRIC TECHNICIAN