Healthcare Provider Details

I. General information

NPI: 1033005988
Provider Name (Legal Business Name): ZACHARY D GIERTYCH M.ED., BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 E GREENLAW LN STE 12A
FLAGSTAFF AZ
86004-1849
US

IV. Provider business mailing address

2323 E GREENLAW LN STE 12A
FLAGSTAFF AZ
86004-1849
US

V. Phone/Fax

Practice location:
  • Phone: 928-275-1339
  • Fax: 928-222-1339
Mailing address:
  • Phone: 928-275-1339
  • Fax: 928-222-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001269
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: