Healthcare Provider Details

I. General information

NPI: 1659911824
Provider Name (Legal Business Name): ALLISON LEE HOLLOWAY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5108 S U ST
FORT SMITH AR
72903-3610
US

IV. Provider business mailing address

910 S GREENWOOD AVE
FORT SMITH AR
72901-4130
US

V. Phone/Fax

Practice location:
  • Phone: 479-276-9900
  • Fax: 479-401-2595
Mailing address:
  • Phone: 479-276-9900
  • Fax: 479-401-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47135
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19-97458
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: