Provider Demographics
NPI:1154588879
Name:HOLMES, ROBYN L (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ENCHANTED PKWY
Mailing Address - Street 2:APT 304
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-5453
Mailing Address - Country:US
Mailing Address - Phone:636-220-7258
Mailing Address - Fax:
Practice Address - Street 1:210 ENCHANTED PKWY
Practice Address - Street 2:APT 304
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-5453
Practice Address - Country:US
Practice Address - Phone:636-220-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral