Provider Demographics
NPI:1982297560
Name:HOLY, EVELYN (MS BCBA LBA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:HOLY
Suffix:
Gender:F
Credentials:MS BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6948 E HAMPTON AVE STE N-055
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3302
Mailing Address - Country:US
Mailing Address - Phone:888-975-4557
Mailing Address - Fax:
Practice Address - Street 1:6948 E HAMPTON AVE STE N-055
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3302
Practice Address - Country:US
Practice Address - Phone:888-975-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000792103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst