Provider Demographics
NPI:1861006199
Name:CAMACHO, JESSICA YVONNE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:YVONNE
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 N 103RD AVE STE 79
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3060
Mailing Address - Country:US
Mailing Address - Phone:602-772-7818
Mailing Address - Fax:623-806-8656
Practice Address - Street 1:13000 N 103RD AVE STE 79
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3060
Practice Address - Country:US
Practice Address - Phone:602-772-7818
Practice Address - Fax:623-806-8656
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-001216103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst