Provider Demographics
NPI:1760926596
Name:GATES, STEPHANIE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:GATES
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 1:5025 E WASHINGTON ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-7437
Mailing Address - Country:US
Mailing Address - Phone:602-773-5775
Mailing Address - Fax:
Practice Address - Street 1:5025 E WASHINGTON ST
Practice Address - Street 2:SUITE 212
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-7437
Practice Address - Country:US
Practice Address - Phone:602-773-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst