Provider Demographics
NPI:1457109886
Name:HOLMES, BROOKE GENEVIEVE (MFT-I)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:GENEVIEVE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9835 SILVER CHAPS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6832
Mailing Address - Country:US
Mailing Address - Phone:702-772-8964
Mailing Address - Fax:
Practice Address - Street 1:2298 W HORIZON RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2696
Practice Address - Country:US
Practice Address - Phone:702-363-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist