Provider Demographics
NPI:1316748783
Name:HOLMES, DENEEN AMANDA (MA LPC NCC ALMFT LPN)
Entity type:Individual
Prefix:
First Name:DENEEN
Middle Name:AMANDA
Last Name:HOLMES
Suffix:
Gender:
Credentials:MA LPC NCC ALMFT LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 179TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-2918
Mailing Address - Country:US
Mailing Address - Phone:708-833-9298
Mailing Address - Fax:
Practice Address - Street 1:19624 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2092
Practice Address - Country:US
Practice Address - Phone:872-225-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.001188106H00000X
IL043.116761164W00000X
IL178.019884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse