Provider Demographics
NPI:1558041293
Name:HOLLAND, MADISON ALEXANDRIA (RBT)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ALEXANDRIA
Last Name:HOLLAND
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 1:1034 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-4148
Mailing Address - Country:US
Mailing Address - Phone:325-201-1308
Mailing Address - Fax:
Practice Address - Street 1:749 GATEWAY STE 702
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1543
Practice Address - Country:US
Practice Address - Phone:325-225-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX962279106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician