Provider Demographics
NPI:1023124559
Name:HOLMES, DAN (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:HOLMES
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2912 KING ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5321
Mailing Address - Country:US
Mailing Address - Phone:870-910-3757
Mailing Address - Fax:870-910-4999
Practice Address - Street 1:2912 KING ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5321
Practice Address - Country:US
Practice Address - Phone:870-910-3757
Practice Address - Fax:870-910-4999
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9605014101YP2500X
ARM9805025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist