Healthcare Provider Details

I. General information

NPI: 1992252571
Provider Name (Legal Business Name): HOLLY LYNN SUTTON BS, AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 KERN ROAD CHILDREN'S VILLAGE
YAKIMA WA
98902
US

IV. Provider business mailing address

5301 TIETON DR STE C 5301 TIETON DRIVE SUITE C
YAKIMA WA
98908-3479
US

V. Phone/Fax

Practice location:
  • Phone: 509-574-3267
  • Fax: 509-574-6710
Mailing address:
  • Phone: 509-965-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA60828820
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberCG60672517
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: