Provider Demographics
NPI:1013946151
Name:HOLMES, ELIZABETH R (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:H
Other - Last Name:BING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2108 BRAEWICK CIR
Mailing Address - Street 2:STE 202
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6260
Mailing Address - Country:US
Mailing Address - Phone:330-920-9292
Mailing Address - Fax:330-920-9393
Practice Address - Street 1:2108 BRAEWICK CIR
Practice Address - Street 2:STE 202
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6260
Practice Address - Country:US
Practice Address - Phone:330-920-9292
Practice Address - Fax:330-920-9393
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2421703Medicaid
OH9376051Medicare PIN
OH2421703Medicaid