Provider Demographics
NPI:1124776323
Name:HOLMES, STACIE AUSBON (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:AUSBON
Last Name:HOLMES
Suffix:
Gender:
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710-4009
Mailing Address - Country:US
Mailing Address - Phone:225-573-5098
Mailing Address - Fax:
Practice Address - Street 1:6711 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:ADDIS
Practice Address - State:LA
Practice Address - Zip Code:70710-4009
Practice Address - Country:US
Practice Address - Phone:225-573-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9035101YP2500X
LAPLC9035101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional