Provider Demographics
NPI:1184997025
Name:HOLMAN, DORETHA
Entity type:Individual
Prefix:
First Name:DORETHA
Middle Name:
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4209 NW 23RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2645
Mailing Address - Country:US
Mailing Address - Phone:405-602-5086
Mailing Address - Fax:405-602-5088
Practice Address - Street 1:4209 NW 23RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2645
Practice Address - Country:US
Practice Address - Phone:405-602-5086
Practice Address - Fax:405-602-5088
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst