Provider Demographics
NPI:1346074150
Name:HOLLIS, TY'ONNA K (RBT)
Entity type:Individual
Prefix:MISS
First Name:TY'ONNA
Middle Name:K
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 103RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6877
Mailing Address - Country:US
Mailing Address - Phone:904-701-0317
Mailing Address - Fax:904-736-7546
Practice Address - Street 1:6850 103RD ST STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6877
Practice Address - Country:US
Practice Address - Phone:904-701-0317
Practice Address - Fax:904-736-7546
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-372783106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician