Provider Demographics
NPI:1558992354
Name:DAVIS, TALIA LASANDRA (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:LASANDRA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1267 W CARLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4350
Mailing Address - Country:US
Mailing Address - Phone:602-803-2797
Mailing Address - Fax:
Practice Address - Street 1:15820 N 35TH AVE STE 14
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-7608
Practice Address - Country:US
Practice Address - Phone:602-526-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000509103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst