Healthcare Provider Details

I. General information

NPI: 1194132969
Provider Name (Legal Business Name): TREICHAE JANAE HAYS HOLMES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 08/04/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PEACHTREE ST NE STE 100
ATLANTA GA
30361-3503
US

IV. Provider business mailing address

1821 AGARITO DRIVE
WEATHERFORD TX
76086
US

V. Phone/Fax

Practice location:
  • Phone: 469-337-1935
  • Fax:
Mailing address:
  • Phone: 469-337-1935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16783
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1171
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16783
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: