Provider Demographics
NPI:1225681513
Name:HOLDER, NATALIE RENEE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RENEE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:RENEE
Other - Last Name:MAJORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8922 161ST ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-3001
Mailing Address - Country:US
Mailing Address - Phone:937-901-9470
Mailing Address - Fax:
Practice Address - Street 1:331 LANDRUM PL
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6329
Practice Address - Country:US
Practice Address - Phone:931-553-1395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TN836103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician