Provider Demographics
NPI:1417162033
Name:HOLMES, SHELIA ANNETTE (BA)
Entity Type:Individual
Prefix:MRS
First Name:SHELIA
Middle Name:ANNETTE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-1424
Mailing Address - Country:US
Mailing Address - Phone:580-726-3176
Mailing Address - Fax:580-782-3338
Practice Address - Street 1:2 WICKERSHAM ST
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-9117
Practice Address - Country:US
Practice Address - Phone:580-782-3337
Practice Address - Fax:580-782-3338
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)