Provider Demographics
NPI:1437493939
Name:HOLLEY, KATHRYN (BCBA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:HOLLEY
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 1:1900 COMMERCE ST
Mailing Address - Street 2:MDS110
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3112
Mailing Address - Country:US
Mailing Address - Phone:253-692-4758
Mailing Address - Fax:
Practice Address - Street 1:1900 COMMERCE ST
Practice Address - Street 2:MDS110
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3112
Practice Address - Country:US
Practice Address - Phone:253-692-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCABA 0-12-5122103K00000X
WA1-15-18635103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst