Provider Demographics
NPI:1710429345
Name:LOCKE, MARIAH (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:
Other - Last Name:BAYSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:3150 N 24TH ST STE C102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3150 N 24TH ST STE C102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7343
Practice Address - Country:US
Practice Address - Phone:602-206-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-0252103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst