Healthcare Provider Details

I. General information

NPI: 1912651894
Provider Name (Legal Business Name): COURTNEY DENEVI BCBA, LBA, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 S GILBERT RD
MESA AZ
85204-6000
US

IV. Provider business mailing address

1555 S GILBERT RD
MESA AZ
85204-6000
US

V. Phone/Fax

Practice location:
  • Phone: 480-750-7058
  • Fax:
Mailing address:
  • Phone: 480-750-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22770
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-18370
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: