Healthcare Provider Details

I. General information

NPI: 1013879220
Provider Name (Legal Business Name): KENNETH CURTIS HOLT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 W ROSE GARDEN LN STE 4
PHOENIX AZ
85027-2725
US

IV. Provider business mailing address

1831 W ROSE GARDEN LN STE 4
PHOENIX AZ
85027-2725
US

V. Phone/Fax

Practice location:
  • Phone: 602-808-9912
  • Fax:
Mailing address:
  • Phone: 602-808-9912
  • Fax: 602-808-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-249392
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: