Provider Demographics
NPI:1548385289
Name:HOLMES, CYNTHIA MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2961 E HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3769
Mailing Address - Country:US
Mailing Address - Phone:626-918-2085
Mailing Address - Fax:
Practice Address - Street 1:1501 W CAMERON AVE
Practice Address - Street 2:SUITE 110-5
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2724
Practice Address - Country:US
Practice Address - Phone:626-221-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA800396315OtherTAX I D NUMBER