Healthcare Provider Details

I. General information

NPI: 1235033713
Provider Name (Legal Business Name): STACY L SMITH MBA, MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 W 14TH ST STE 121
TEMPE AZ
85281-6917
US

IV. Provider business mailing address

2005 W 14TH ST STE 121
TEMPE AZ
85281-6917
US

V. Phone/Fax

Practice location:
  • Phone: 480-826-3005
  • Fax: 480-535-1091
Mailing address:
  • Phone: 480-826-3005
  • Fax: 480-535-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: