Healthcare Provider Details

I. General information

NPI: 1497368765
Provider Name (Legal Business Name): AUBREY HELENA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUBREY GARNETT

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20860 N TATUM BLVD STE 300
PHOENIX AZ
85050-4283
US

IV. Provider business mailing address

20860 N TATUM BLVD STE 300
PHOENIX AZ
85050-4283
US

V. Phone/Fax

Practice location:
  • Phone: 866-342-8847
  • Fax: 866-342-8847
Mailing address:
  • Phone: 866-342-8847
  • Fax: 866-342-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74291
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: