Doctor Name: | MR. BRAD K HOLMGREN |
NPI Number: | 1699804286 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LISW |
License Number: | I3761 |
Business Practice Address: | 900 Central Bayard, NM - 88023 |
Business Phone Number: | 5055374000 |
Business Fax Number: | 5055373358 |
Mailing Address: | 226 N. California Ave, SILVER CITY |
State: | NM |
Postal Code: | 88061 |
Phone Number: | 5053880263 |
Fax Number: | |
NPI Enumeration Date: | 03/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | I3761 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |