Basic Information
| Provider Information | |||||||||
| NPI: | 1306219258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMES | ||||||||
| FirstName: | OLIVE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHARLES | ||||||||
| OtherFirstName: | OLIVE | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8 WILLOW PL | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813014459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707997780 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 281 SAWYER DR | ||||||||
| Address2: | #100 | ||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813033409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702592162 | ||||||||
| FaxNumber: | 9702475255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2015 | ||||||||
| LastUpdateDate: | 10/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 09924104 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.