Provider Demographics
NPI:1730604679
Name:BARHOLD, THERESA CATHERINE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:CATHERINE
Last Name:BARHOLD
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:RESA
Other - Middle Name:CATHERINE
Other - Last Name:BARHOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:1912 GLEN MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4719
Mailing Address - Country:US
Mailing Address - Phone:321-394-5484
Mailing Address - Fax:
Practice Address - Street 1:1912 GLEN MEADOWS CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4719
Practice Address - Country:US
Practice Address - Phone:321-394-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-20-44991103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician