Provider Demographics
NPI:1184188617
Name:MOCK, TRACY (BCBA)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MOCK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16025 S 50TH ST APT 3019
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-5022
Mailing Address - Country:US
Mailing Address - Phone:630-915-9639
Mailing Address - Fax:
Practice Address - Street 1:4530 E RAY RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6095
Practice Address - Country:US
Practice Address - Phone:480-608-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician