Provider Demographics
NPI:1720524226
Name:HOLMAN, COREY
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:HOLMAN
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 1:15500 JEFFERSONS GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1410
Mailing Address - Country:US
Mailing Address - Phone:405-330-8200
Mailing Address - Fax:405-330-8209
Practice Address - Street 1:15500 JEFFERSONS GARDEN CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1410
Practice Address - Country:US
Practice Address - Phone:405-330-8200
Practice Address - Fax:405-330-8209
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician