Healthcare Provider Details

I. General information

NPI: 1992211379
Provider Name (Legal Business Name): TYNE ALUCIA WILLIAMS BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N ESTRELLA PKWY STE 215&230
GOODYEAR AZ
85338-9271
US

IV. Provider business mailing address

3030 CALLE FRONTERA
SAN CLEMENTE CA
92673-3009
US

V. Phone/Fax

Practice location:
  • Phone: 628-833-8424
  • Fax:
Mailing address:
  • Phone: 949-272-6146
  • Fax: 888-847-8864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number02515825
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-38132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: