Provider Demographics
NPI:1750062600
Name:HOLMES, AUTUMN BROOKE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:BROOKE
Last Name:HOLMES
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 1:1143 LEGACY WAY
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-7471
Mailing Address - Country:US
Mailing Address - Phone:307-871-0724
Mailing Address - Fax:
Practice Address - Street 1:215 PITKIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7805
Practice Address - Country:US
Practice Address - Phone:970-986-8668
Practice Address - Fax:970-986-8586
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1385101Y00000X, 101YM0800X
COLPCC.0021824101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor