Provider Demographics
NPI:1750917332
Name:EASTERLY, HOLLY (BCBA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:EASTERLY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 DANIEL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6031
Mailing Address - Country:US
Mailing Address - Phone:931-287-3710
Mailing Address - Fax:931-287-2778
Practice Address - Street 1:31 DANIEL DR STE 101
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6031
Practice Address - Country:US
Practice Address - Phone:931-287-3710
Practice Address - Fax:931-287-2778
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-41724OtherBEHAVIOR ANALYSIS CERTIFICATION BOARD