Provider Demographics
NPI:1992194542
Name:HOLMES, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6965 EL CAMINO REAL
Mailing Address - Street 2:SUITE 105-432
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:531 ENCINITAS BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3741
Practice Address - Country:US
Practice Address - Phone:858-880-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist