Provider Demographics
NPI:1174923197
Name:ARIZONA BEHAVIOR & AUTISM LLC
Entity type:Organization
Organization Name:ARIZONA BEHAVIOR & AUTISM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTRANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:LBA BCBA
Authorized Official - Phone:520-820-3650
Mailing Address - Street 1:4885 S HOUGHTON RD # A
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-5201
Mailing Address - Country:US
Mailing Address - Phone:520-820-3650
Mailing Address - Fax:520-722-7038
Practice Address - Street 1:4885 S HOUGHTON RD UNIT 1
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-5202
Practice Address - Country:US
Practice Address - Phone:520-820-3650
Practice Address - Fax:520-722-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ83251C00000X, 252Y00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency