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General NPI Number Information
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NPI Number | 1285988352
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Entity Type | Individual
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Provider Name | MALLORY RAYE SMITH M.A., BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 1835 E GUADALUPE RD SUITE #103
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City | TEMPE
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State | AZ
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Zip | 85283-3277
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Country | US
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Telephone | 480-659-5456
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Fax | 480-838-1828
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Provider Business Mailing Address
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Address Line | 1835 E GUADALUPE RD SUITE #103
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City | TEMPE
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State | AZ
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Zip | 85283-3277
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Country | US
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Telephone | 480-659-5456
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Fax | 480-838-1828
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-193
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License Number State | AZ
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