Provider Demographics
NPI:1003089897
Name:HOLTON, BETHANY (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:HOLTON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 WHITE BRIDGE RD
Mailing Address - Street 2:STE. 103-232
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1444
Mailing Address - Country:US
Mailing Address - Phone:615-916-0664
Mailing Address - Fax:615-953-2949
Practice Address - Street 1:73 WHITE BRIDGE RD
Practice Address - Street 2:STE. 103-232
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1444
Practice Address - Country:US
Practice Address - Phone:615-916-0664
Practice Address - Fax:615-953-2949
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511682Medicaid