Provider Demographics
NPI:1811365463
Name:HOLMES, LISA MARIE (MA, LSC, LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MA, LSC, LPC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:HELSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LSC, LPC
Mailing Address - Street 1:928 S GARFIELD AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2403
Mailing Address - Country:US
Mailing Address - Phone:231-649-0749
Mailing Address - Fax:
Practice Address - Street 1:928 S GARFIELD AVE STE 3
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2403
Practice Address - Country:US
Practice Address - Phone:231-649-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional