Healthcare Provider Details

I. General information

NPI: 1639655335
Provider Name (Legal Business Name): MACEY WHITE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9538 VILLAGE TREE DR
ELK GROVE CA
95758-1196
US

IV. Provider business mailing address

9538 VILLAGE TREE DR
ELK GROVE CA
95758-1196
US

V. Phone/Fax

Practice location:
  • Phone: 279-210-5088
  • Fax:
Mailing address:
  • Phone: 279-210-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: