Provider Demographics
NPI:1477199438
Name:HOLMES, PATRICK LYNN
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LYNN
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 WESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3347
Mailing Address - Country:US
Mailing Address - Phone:254-624-0300
Mailing Address - Fax:
Practice Address - Street 1:2308 WESTWOOD LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3347
Practice Address - Country:US
Practice Address - Phone:254-624-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician