Provider Demographics
NPI:1952947699
Name:BAKAZAN, STEPHANIE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BAKAZAN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S DOBSON RD # 9
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6481
Mailing Address - Country:US
Mailing Address - Phone:602-926-7200
Mailing Address - Fax:602-368-2730
Practice Address - Street 1:2222 S DOBSON RD # 9
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6481
Practice Address - Country:US
Practice Address - Phone:602-926-7200
Practice Address - Fax:602-368-2730
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000507103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst