Provider Demographics
NPI:1134764772
Name:HOLLAND, BETHANY S (MS, BCBA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:S
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:IA
Mailing Address - Zip Code:52136-2030
Mailing Address - Country:US
Mailing Address - Phone:563-203-2327
Mailing Address - Fax:
Practice Address - Street 1:540 3RD ST SE
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-2030
Practice Address - Country:US
Practice Address - Phone:563-203-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
1-21-52419103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner