Provider Demographics
NPI:1548267719
Name:HOLMES, PETER F (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:F
Last Name:HOLMES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5316 GODAS CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-2980
Mailing Address - Country:US
Mailing Address - Phone:573-814-3632
Mailing Address - Fax:
Practice Address - Street 1:3201 S PROVIDENCE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3622
Practice Address - Country:US
Practice Address - Phone:573-875-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166307103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000021938Medicare ID - Type UnspecifiedPSYCHOLOGIST