Individual provider Active NPI

Madison Kendra Holm, , LMHC, LSAA

  • Mental Health Counselor
  • Roswell, NM
National Provider Identifier
1154939502
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
CTB-2024-0587 Issued in NM
Practice address
110 E Mescalero Rd
Roswell, NM 88201-6542
Phone
(575) 755-2272
Fax
(575) 623-3325
NPI assigned
Jul 21, 2020
Last updated
Sep 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CTB-2024-0640 NM
Mental Health Counselor 101YM0800X CTB-2024-0587 NM Primary

Addresses

Primary practice location

110 E Mescalero Rd
Roswell, NM 88201-6542

Mailing address

110 E Mescalero Rd
Roswell, NM 88201-6542
Phone (575) 755-2272

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CTB-2024-0640NMMDAddiction (Substance Use Disorder) Counselor
CTB-2024-0587NMMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1154939502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E MESCALERO RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882016542",
            "telephone_number": "575-755-2272",
            "fax_number": "575-623-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E MESCALERO RD",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882016542",
            "telephone_number": "575-755-2272",
            "fax_number": "575-623-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLM",
        "first_name": "MADISON",
        "middle_name": "KENDRA",
        "credential": ", LMHC, LSAA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-21",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NM",
            "license": "CTB-2024-0640",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CTB-2024-0587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.