Healthcare Provider Details

I. General information

NPI: 1023400488
Provider Name (Legal Business Name): JONATHAN RICHARD PARDEE M.S.W., B.C.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 16TH STREET #1017
YUMA AZ
85364-4733
US

IV. Provider business mailing address

7108 SOUTH KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 855-832-6727
  • Fax: 772-675-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000160
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: