Provider Demographics
NPI:1164907036
Name:HOLLEY, BETHANY HANNAH NICOLE (RBT)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:HANNAH NICOLE
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 SAMPSON ST APT 3103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7875
Mailing Address - Country:US
Mailing Address - Phone:979-215-1261
Mailing Address - Fax:
Practice Address - Street 1:16341 MUESCHKE RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5215
Practice Address - Country:US
Practice Address - Phone:832-334-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician