Healthcare Provider Details

I. General information

NPI: 1902345820
Provider Name (Legal Business Name): DYLAN HUFF BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 W MCDOWELL RD SUITE E5013
AVONDALE AZ
85392-4863
US

IV. Provider business mailing address

10320 W MCDOWELL RD SUITE E5013
AVONDALE AZ
85392-4863
US

V. Phone/Fax

Practice location:
  • Phone: 855-223-7123
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number267
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: