Provider Demographics
NPI:1821878588
Name:HOLMES, ROSALYN NYQUITA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:NYQUITA
Last Name:HOLMES
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4057 RILEY FUZZEL RD STE 500-401
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-4632
Mailing Address - Country:US
Mailing Address - Phone:254-319-0952
Mailing Address - Fax:
Practice Address - Street 1:27855 SERENATA SPRINGS DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-4926
Practice Address - Country:US
Practice Address - Phone:254-319-0952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-23-67784103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst