Provider Demographics
NPI:1649794116
Name:TAPIA, MATTHEW RYAN (MA, BCBA, LMFT, LBA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:TAPIA
Suffix:
Gender:M
Credentials:MA, BCBA, LMFT, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:3602 E GREENWAY RD STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4648
Practice Address - Country:US
Practice Address - Phone:602-560-2832
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15945106H00000X
CA131725106H00000X
AZBEH-000768103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-32020OtherBCBA CERTIFICATE