Provider Demographics
NPI:1891558235
Name:HOLT-MIDDLETON, T'HANI
Entity Type:Individual
Prefix:
First Name:T'HANI
Middle Name:
Last Name:HOLT-MIDDLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 PIUTE RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80926-9729
Mailing Address - Country:US
Mailing Address - Phone:706-887-9253
Mailing Address - Fax:
Practice Address - Street 1:421 WINDCHIME PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1984
Practice Address - Country:US
Practice Address - Phone:706-887-9253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician