Provider Demographics
NPI:1598866196
Name:HOLMES, LAURA MASTERSON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MASTERSON
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:HYDESVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95547-0161
Mailing Address - Country:US
Mailing Address - Phone:707-407-8038
Mailing Address - Fax:707-476-8554
Practice Address - Street 1:3172 WALFORD AVE STE 4
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4898
Practice Address - Country:US
Practice Address - Phone:707-407-8038
Practice Address - Fax:707-476-8554
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS139691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29902ZMedicare ID - Type UnspecifiedPSYCHOTHERAPIST