Provider Demographics
NPI:1336781186
Name:HOLMES, TAYLOR (LMFT152559)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:
Last Name:HOLMES
Suffix:
Gender:
Credentials:LMFT152559
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1701
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92018
Mailing Address - Country:US
Mailing Address - Phone:760-917-0545
Mailing Address - Fax:
Practice Address - Street 1:3704 PRIMROSE RD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8822
Practice Address - Country:US
Practice Address - Phone:760-917-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALMFT152559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health