Provider Demographics
NPI:1013900521
Name:HOLMES, JUANITA (PLCSW)
Entity type:Individual
Prefix:MS
First Name:JUANITA
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-4402
Mailing Address - Country:US
Mailing Address - Phone:660-827-4449
Mailing Address - Fax:660-827-6489
Practice Address - Street 1:108 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-4402
Practice Address - Country:US
Practice Address - Phone:660-827-4449
Practice Address - Fax:660-827-6489
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005002295104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker