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General NPI Number Information
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NPI Number | 1134984297
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Entity Type | Individual
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Provider Name | JOHN D HOLLAND
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Gender | Male
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 6418 S 69TH GLN
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City | LAVEEN
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State | AZ
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Zip | 85339-2696
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Country | US
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Telephone | 480-524-1814
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 S POWER RD STE 504
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City | MESA
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State | AZ
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Zip | 85206-3715
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Country | US
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Telephone | 520-582-6464
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BH8986
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License Number State | AZ
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