Healthcare Provider Details

I. General information

NPI: 1497239107
Provider Name (Legal Business Name): PAULINE CRYSTAL BROWN MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10738 N 184TH DR
SURPRISE AZ
85388-2308
US

IV. Provider business mailing address

10738 N 184TH DR
SURPRISE AZ
85388-2308
US

V. Phone/Fax

Practice location:
  • Phone: 480-865-9506
  • Fax: 368-703-1162
Mailing address:
  • Phone: 480-865-9506
  • Fax: 368-703-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000707
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: