Provider Demographics
NPI:1700610813
Name:PETERMAN, HOLLY DANIELLE (RBT)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:DANIELLE
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:DANIELLE
Other - Last Name:PETERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:2612 W LAMBERTH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5181
Mailing Address - Country:US
Mailing Address - Phone:254-249-6530
Mailing Address - Fax:
Practice Address - Street 1:2612 W LAMBERTH RD STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5181
Practice Address - Country:US
Practice Address - Phone:254-249-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-363982103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst