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General NPI Number Information
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NPI Number | 1639862139
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Entity Type | Individual
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Provider Name | HOLLY ELLIS
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Gender | Female
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 2815 LONGVIEW DR
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City | JONESBORO
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State | AR
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Zip | 72401-5919
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Country | US
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Telephone | 870-842-3274
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 WILDFLOWER CT
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City | JONESBORO
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State | AR
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Zip | 72404-8882
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Country | US
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Telephone | 870-340-7808
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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 | RBT-23-272646
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-84897
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-25-16190
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License Number State | AR
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