Provider Demographics
NPI:1760615504
Name:HOLMES, THOMAS M (DMIN)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2710
Mailing Address - Country:US
Mailing Address - Phone:419-228-2070
Mailing Address - Fax:419-228-0725
Practice Address - Street 1:1130 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2710
Practice Address - Country:US
Practice Address - Phone:419-228-2070
Practice Address - Fax:419-228-0725
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral