Provider Demographics
NPI:1457767501
Name:WHITE, REBECCA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19945 E CAMINA PLATA
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8248
Mailing Address - Country:US
Mailing Address - Phone:310-944-1988
Mailing Address - Fax:
Practice Address - Street 1:2487 S GILBERT RD STE 106-153
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2807
Practice Address - Country:US
Practice Address - Phone:480-744-5286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-31598103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst