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General NPI Number Information
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NPI Number | 1487590410
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Entity Type | Individual
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Provider Name | JEREMY RANDAL COREY HOLT
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Gender | Male
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Dates
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Enumeration Date | 04/23/2026
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Last Update Date | 04/23/2026
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Provider Practice Location Address
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Address Line | 14040 N CAVE CREEK RD FL 3
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City | PHOENIX
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State | AZ
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Zip | 85022-6117
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Country | US
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Telephone | 480-292-9411
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Fax |
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Provider Business Mailing Address
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Address Line | 610 E BELL RD STE 2-229
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City | PHOENIX
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State | AZ
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Zip | 85022-2397
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Country | US
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Telephone | 480-647-1643
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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 |
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License Number State | AZ
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