Provider Demographics
NPI:1396931630
Name:HOLMES, MADGE CLARE (PHD)
Entity type:Individual
Prefix:DR
First Name:MADGE
Middle Name:CLARE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 ZURICH DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7524
Mailing Address - Country:US
Mailing Address - Phone:719-282-6248
Mailing Address - Fax:719-282-6249
Practice Address - Street 1:4157 ZURICH DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7524
Practice Address - Country:US
Practice Address - Phone:719-282-6248
Practice Address - Fax:719-282-6249
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25576106H00000X
CA164515163W00000X
CO855106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse