Provider Demographics
NPI:1467843433
Name:HOLMES, MILDRED V (LCPC)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:V
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BAYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1607
Mailing Address - Country:US
Mailing Address - Phone:815-725-1440
Mailing Address - Fax:815-725-1550
Practice Address - Street 1:300 REPUBLIC AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6520
Practice Address - Country:US
Practice Address - Phone:815-725-1440
Practice Address - Fax:815-725-1550
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180000404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional