Healthcare Provider Details

I. General information

NPI: 1992652721
Provider Name (Legal Business Name): ODYSSEY NICOLE HOLLOMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 3 MILE RD NW
GRAND RAPIDS MI
49544-1685
US

IV. Provider business mailing address

1428 E ALCOTT ST
KALAMAZOO MI
49001-4345
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 859-755-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: