Individual
JACOB D HOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
3616 118 TH STREET CT NW, GIG HARBOR, WA 98332-6867
(844) 362-7943
Mailing address
3014 E CAMELBACK RD STE 2969, PHOENIX, AZ 85016-4404
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-252314
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-23-252314
PRIVATE INSURANCE
AZ
Enumeration date
03/09/2023
Last updated
03/09/2023
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