Provider Demographics
NPI:1508992876
Name:HOLMES, KATHLEEN R
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:HOLMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MOUNT VERNON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4682
Mailing Address - Country:US
Mailing Address - Phone:740-507-4014
Mailing Address - Fax:
Practice Address - Street 1:505 MOUNT VERNON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4682
Practice Address - Country:US
Practice Address - Phone:740-507-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0602104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional