Healthcare Provider Details

I. General information

NPI: 1710429345
Provider Name (Legal Business Name): MARIAH LOCKE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAH BAYSINGER BCBA

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6948 E HAMPTON AVE STE N-055
MESA AZ
85209-3302
US

IV. Provider business mailing address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5312
US

V. Phone/Fax

Practice location:
  • Phone: 480-401-4777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-0252
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: