Provider Demographics
NPI:1225151293
Name:CHATHAM-HAHN, CARY L (BCBA)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:L
Last Name:CHATHAM-HAHN
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:PO BOX 85426
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-5426
Mailing Address - Country:US
Mailing Address - Phone:520-240-1048
Mailing Address - Fax:
Practice Address - Street 1:401 N BONITA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2750
Practice Address - Country:US
Practice Address - Phone:520-721-1887
Practice Address - Fax:520-207-5963
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
AZBEH000307103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBEH000307OtherAZ BOARD OF PSYCHOLOGIST EXAMINERS
AZ364354Medicaid