Healthcare Provider Details

I. General information

NPI: 1508257619
Provider Name (Legal Business Name): HOLLI ELIZABETH PERRIN MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N 5TH ST
GOSHEN IN
46528
US

IV. Provider business mailing address

66208 GRASSLANDS LN
GOSHEN IN
46526-7323
US

V. Phone/Fax

Practice location:
  • Phone: 267-980-9785
  • Fax:
Mailing address:
  • Phone: 267-980-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: