Provider Demographics
NPI:1699046425
Name:HOLDERBY, PATRICIA BLANCHE (MSED)
Entity type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:BLANCHE
Last Name:HOLDERBY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15641 W 871 RD
Mailing Address - Street 2:
Mailing Address - City:PARK HILL
Mailing Address - State:OK
Mailing Address - Zip Code:74451-4063
Mailing Address - Country:US
Mailing Address - Phone:918-457-4759
Mailing Address - Fax:
Practice Address - Street 1:15641 W 871 RD
Practice Address - Street 2:
Practice Address - City:PARK HILL
Practice Address - State:OK
Practice Address - Zip Code:74451-4063
Practice Address - Country:US
Practice Address - Phone:918-457-4759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst