Provider Demographics
NPI:1437639713
Name:HOLMES, KRISTEN ELAINE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELAINE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LMFT
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 692891
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-2891
Mailing Address - Country:US
Mailing Address - Phone:209-518-2623
Mailing Address - Fax:
Practice Address - Street 1:1305 E VINE ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3148
Practice Address - Country:US
Practice Address - Phone:209-331-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist