Provider Demographics
NPI:1740696673
Name:ARIZONA BEHAVIOR & AUTISM LLC
Entity type:Organization
Organization Name:ARIZONA BEHAVIOR & AUTISM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTRANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, LBA
Authorized Official - Phone:520-820-3650
Mailing Address - Street 1:4885 S HOUGHTON RD
Mailing Address - Street 2:A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-5201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4885 S HOUGHTON RD
Practice Address - Street 2:A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-5201
Practice Address - Country:US
Practice Address - Phone:520-820-3650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ83261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities