Provider Demographics
NPI:1548638281
Name:HOLBERY, DANIEL A (MED)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:HOLBERY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:140 N TUCSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-4740
Mailing Address - Country:US
Mailing Address - Phone:520-881-1292
Mailing Address - Fax:520-881-1648
Practice Address - Street 1:140 N TUCSON BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4740
Practice Address - Country:US
Practice Address - Phone:520-881-1292
Practice Address - Fax:520-881-1648
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-0190103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-0190OtherARIZONA STATE BOARD OF PSYCHOLOGIST EXAMINERS