Provider Demographics
NPI:1851690002
Name:HOLCOMB, DUSTIN M (BCBA)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:M
Last Name:HOLCOMB
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 N UNION BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4083
Mailing Address - Country:US
Mailing Address - Phone:970-219-9089
Mailing Address - Fax:720-269-8318
Practice Address - Street 1:7730 N UNION BLVD STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4083
Practice Address - Country:US
Practice Address - Phone:970-219-9089
Practice Address - Fax:720-269-8318
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-11-8400103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst