Basic Information
| Provider Information | |||||||||
| NPI: | 1477760288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLMAN | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | |||||||||
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| Credential: | CDP, LMHC, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 132 | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985920132 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7440 W MARGINAL WAY S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981084141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067681990 | ||||||||
| FaxNumber: | 2067688910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CP00003111 | WA | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | LH00006808 | WA | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | LW00006768 | WA | X | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.