Provider Demographics
NPI:1417949207
Name:HOLMAN, GLENN COURTIER (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:COURTIER
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-0901
Mailing Address - Country:US
Mailing Address - Phone:507-334-6518
Mailing Address - Fax:507-333-2307
Practice Address - Street 1:329 FARIBAULT RD
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5780
Practice Address - Country:US
Practice Address - Phone:507-334-6518
Practice Address - Fax:507-333-2307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1789103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
111539OtherSOUTH COUNTRY
HP23973OtherHEALTH PARTNERS
6120227OtherUNITED HEALTHCARE SERVICE
1010212OtherPREFERRED ONE
83D88HOOtherBLUE CROSS BLUE SHIELD
111539OtherUCARE OF MN