Provider Demographics
NPI:1750556189
Name:HOLMEN, MARTIN LELAND (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LELAND
Last Name:HOLMEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 ROCKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6715
Mailing Address - Country:US
Mailing Address - Phone:805-549-0846
Mailing Address - Fax:
Practice Address - Street 1:3295 ROCKVIEW PL
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6715
Practice Address - Country:US
Practice Address - Phone:805-549-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-27
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6447103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical