Provider Demographics
NPI:1407396906
Name:AYALA, MARY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ROSADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5212 ALLEGANY DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5648
Mailing Address - Country:US
Mailing Address - Phone:719-352-2970
Mailing Address - Fax:
Practice Address - Street 1:4003 W STAN SCHLUETER LOOP STE 3
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-6120
Practice Address - Country:US
Practice Address - Phone:719-352-2970
Practice Address - Fax:254-267-1091
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8347106S00000X
TX3010103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician