Healthcare Provider Details

I. General information

NPI: 1629584990
Provider Name (Legal Business Name): LANDY G BARWICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 S 8TH AVE STE C
YUMA AZ
85364-7154
US

IV. Provider business mailing address

2741 S 8TH AVE STE C
YUMA AZ
85364-7154
US

V. Phone/Fax

Practice location:
  • Phone: 928-782-1338
  • Fax: 928-244-0411
Mailing address:
  • Phone: 928-782-1338
  • Fax: 928-244-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000522
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-1621554
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: