Provider Demographics
NPI:1720304173
Name:HEIM, MAYA (BA, MS, BCBA)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:HEIM
Suffix:
Gender:F
Credentials:BA, MS, BCBA
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:SHALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4800 NE 50TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2672
Mailing Address - Country:US
Mailing Address - Phone:907-232-4989
Mailing Address - Fax:
Practice Address - Street 1:540 JEPSON CIR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-232-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK117450OtherBEHAVIOR ANALYST LICENSE
1-09-5831OtherBACB-BOARD CERTIFIED BEHAVIOR ANALYST