Provider Demographics
NPI:1639362296
Name:HOLMBERG, JOHN RANDALL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RANDALL
Last Name:HOLMBERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 S CURTICE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1909
Mailing Address - Country:US
Mailing Address - Phone:303-503-4448
Mailing Address - Fax:303-586-6286
Practice Address - Street 1:5860 S CURTICE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1909
Practice Address - Country:US
Practice Address - Phone:303-503-4448
Practice Address - Fax:303-586-6286
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2534103TC0700X
103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent