Provider Demographics
NPI:1992034300
Name:HOLMES, CAMILLE LUCILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:LUCILLE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4555
Mailing Address - Country:US
Mailing Address - Phone:209-591-3680
Mailing Address - Fax:
Practice Address - Street 1:716 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4555
Practice Address - Country:US
Practice Address - Phone:209-591-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13644103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist