Individual provider Active NPI

Sandra Holmes, PHD

  • Professional Counselor
  • Tupelo, MS
National Provider Identifier
1649890336
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
0377 Issued in MS
Practice address
4579 S Eason Blvd
Tupelo, MS 38801-6539
Phone
(662) 377-3161
NPI assigned
Apr 22, 2020
Last updated
Apr 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 0377 MS Primary

Addresses

Primary practice location

4579 S Eason Blvd
Tupelo, MS 38801-6539

Mailing address

450 E President Ave
Tupelo, MS 38801-5599
Phone (662) 377-3204

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240214000235 MS Practitioner - Mental Health Counselor 5698119022

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2001
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

808 Varsity Dr
Tupelo, MS 38801-4613

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medcial Center, Inc. CurrentSince Jan 2, 2024 Accepting new patients
North Mississippi Medical Center Inc CurrentSince Jan 2, 2024 Accepting new patients

Locations

450 E President Ave
Tupelo, MS 38801
Phone (662) 377-3204

4579 S Eason Blvd
Tupelo, MS 38801
Phone (662) 377-3161

4579 S Eason Blvd
Ste A
Tupelo, MS 38801
Phone (662) 377-6161

4579 S Eason Blvd
Ste Ef
Tupelo, MS 38801
Phone (662) 377-7590

808 Varsity Dr
Tupelo, MS 38801
Phone (662) 377-2386

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587513600000",
    "number": "1649890336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 E PRESIDENT AVE",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388015599",
            "telephone_number": "662-377-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4579 S EASON BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016539",
            "telephone_number": "662-377-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "SANDRA",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-22",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "0377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.