Provider Demographics
NPI:1215425525
Name:PATRICK, HOLLY (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36602-3809
Mailing Address - Country:US
Mailing Address - Phone:205-522-1481
Mailing Address - Fax:
Practice Address - Street 1:11 NORTH WATER ST
Practice Address - Street 2:10TH FL
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2018-029103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst