Healthcare Provider Details

I. General information

NPI: 1073985909
Provider Name (Legal Business Name): MARIA TRIXY IGNACIO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA TRIXY TITCO

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 BROADWAY STE 301
TACOMA WA
98402-4454
US

IV. Provider business mailing address

3119 13TH AVENUE CT NW
PUYALLUP WA
98371-3893
US

V. Phone/Fax

Practice location:
  • Phone: 253-671-9909
  • Fax:
Mailing address:
  • Phone: 206-851-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61654990
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: