Provider Demographics
NPI:1518439900
Name:HOLMES, KIM DENISE (LMSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:DENISE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 HOOVER DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-2998
Mailing Address - Country:US
Mailing Address - Phone:219-741-3723
Mailing Address - Fax:
Practice Address - Street 1:2150 S CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4070
Practice Address - Country:US
Practice Address - Phone:219-741-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40674101YA0400X
TX65399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)