Provider Demographics
NPI:1659080976
Name:HOLMES, JENNA (CMHC-I)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CMHC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S 700 E STE 102
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2485
Mailing Address - Country:US
Mailing Address - Phone:801-683-6830
Mailing Address - Fax:
Practice Address - Street 1:131 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2485
Practice Address - Country:US
Practice Address - Phone:801-683-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health