Individual
DR. LARRY HOLMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
11102 TUCKAWAY RD, ARBOR VITAE, WI 54568-8913
(715) 358-5400
(715) 358-5405
Mailing address
PO BOX 1309, ARBOR VITAE, WI 54568-1309
(715) 358-5400
(715) 358-5405
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2535
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39148300
—
WI
01
—
WI1253
MEDICARE PTAN
WI
Enumeration date
08/31/2006
Last updated
12/22/2010
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