Provider Demographics
NPI:1457785685
Name:HOLMES, NICHOLE A (BHT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:A
Last Name:HOLMES
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:A
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1817 E SOUTHERN AVE
Mailing Address - Street 2:122
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5814
Mailing Address - Country:US
Mailing Address - Phone:760-277-5562
Mailing Address - Fax:
Practice Address - Street 1:1817 E SOUTHERN AVE
Practice Address - Street 2:122
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5814
Practice Address - Country:US
Practice Address - Phone:760-277-5562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst