Basic Information
| Provider Information | |||||||||
| NPI: | 1932187457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOLUM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 MARKET ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154878067 | ||||||||
| FaxNumber: | 4155589657 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 MARKET ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154878067 | ||||||||
| FaxNumber: | 4155589657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT40503 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.