Provider Demographics
NPI:1760617724
Name:HOLMES, KATHRYN MAE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:MAE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N COURT AVE
Mailing Address - Street 2:PO BOX 501
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1469
Mailing Address - Country:US
Mailing Address - Phone:989-370-0564
Mailing Address - Fax:
Practice Address - Street 1:114 N COURT AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1469
Practice Address - Country:US
Practice Address - Phone:989-370-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional