Provider Demographics
NPI:1710409107
Name:HOLEMAN, KRISTA MARIE (LIMHP, LADC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:HOLEMAN
Suffix:
Gender:F
Credentials:LIMHP, LADC
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:MARIE
Other - Last Name:VIESELMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIMHP, LADC
Mailing Address - Street 1:520 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-1225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1225
Practice Address - Country:US
Practice Address - Phone:402-207-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2018101YM0800X
NE10527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE168976938Medicaid