Individual provider Active NPI

David Carter Holcomb, PHD

  • Clinical Psychologist
  • Las Cruces, NM
National Provider Identifier
1790783868
Registry record updated Nov 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
1056 Issued in NM
Practice address
255 W Hadley Ave
Las Cruces, NM 88005-1806
Phone
(575) 268-2634
Fax
(866) 611-2571
NPI assigned
Jul 12, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 2, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 1056 NM Primary
Clinical Psychologist 103TC0700X PY0765 NV

Addresses

Primary practice location

255 W Hadley Ave
Las Cruces, NM 88005-1806

Mailing address

PO Box 245
San Miguel, NM 88058-0245
Phone (575) 522-5466

Other identifiers 1

IdentifierTypeStateIssuer
NM000650MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
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
I20171207002593 NM Practitioner - Clinical Psychologist 0244291946 Practice locations: Las Cruces, NM

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

255 W Hadley Ave
Las Cruces, NM 88005-1806
Phone (575) 268-2634

PO Box
Suite 245
San Miguel, NM 88058-0245

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PY0765NVMDClinical Psychologist
1056NMMDPeer Specialist

NPI Registry JSON

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509580800000",
    "number": "1790783868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 245",
            "city": "SAN MIGUEL",
            "state": "NM",
            "postal_code": "880580245",
            "telephone_number": "575-522-5466",
            "fax_number": "575-521-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W HADLEY AVE",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880051806",
            "telephone_number": "575-268-2634",
            "fax_number": "866-611-2571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLCOMB",
        "first_name": "DAVID",
        "middle_name": "CARTER",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2017-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NM",
            "license": "1056",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY0765",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NM000650",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

Verify at the official NPI Registry.