Individual provider Active NPI

Holland Berklee Hayes

  • Behavior Technician
  • Prior Lake, MN
National Provider Identifier
1942965413
Registry record updated Nov 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
4532 204TH St E
Prior Lake, MN 55372-7507
Phone
(952) 913-4883
NPI assigned
Nov 1, 2021
Last updated
Nov 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X NU Primary

Addresses

Primary practice location

4532 204TH St E
Prior Lake, MN 55372-7507

Mailing address

10450 185TH St W Ste 100
Lakeville, MN 55044-6696
Phone (612) 509-1283

Other practice location 1

4532 204th St E
Prior Lake, MN 55372-7507
Phone (952) 913-4883

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1942965413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10450 185TH ST W STE 100",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446696",
            "telephone_number": "612-509-1283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4532 204TH ST E",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553727507",
            "telephone_number": "952-913-4883"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4532 204th St E",
            "address_purpose": "LOCATION",
            "city": "Prior Lake",
            "state": "MN",
            "postal_code": "553727507",
            "country_code": "US",
            "telephone_number": "952-913-4883",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAYES",
        "first_name": "HOLLAND",
        "middle_name": "BERKLEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-01",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prior Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.