Provider Demographics
NPI:1982410270
Name:HOLM, CAITLYN LEE
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:LEE
Last Name:HOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1657
Mailing Address - Country:US
Mailing Address - Phone:712-240-0862
Mailing Address - Fax:
Practice Address - Street 1:240 N BLUFF BLVD STE 206
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7146
Practice Address - Country:US
Practice Address - Phone:515-890-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAHOLM-LL2OC0101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health