Provider Demographics
NPI:1265305718
Name:HOLMES, SCOTT ALLAN (LADC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLAN
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1925
Mailing Address - Country:US
Mailing Address - Phone:218-341-3139
Mailing Address - Fax:
Practice Address - Street 1:1150 MISSION RD
Practice Address - Street 2:
Practice Address - City:SAWYER
Practice Address - State:MN
Practice Address - Zip Code:55780
Practice Address - Country:US
Practice Address - Phone:218-879-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN307443101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor