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General NPI Number Information
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NPI Number | 1710649439
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Entity Type | Individual
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Provider Name | KRYSTIN ALYSE ABT
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Gender | Female
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 12725 W INDIAN SCHOOL RD BLDG D
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City | AVONDALE
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State | AZ
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Zip | 85392-9520
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Country | US
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Telephone | 623-207-7190
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Fax |
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Provider Business Mailing Address
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Address Line | 12725 W INDIAN SCHOOL RD BLDG D
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City | AVONDALE
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State | AZ
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Zip | 85392-9520
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Country | US
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Telephone | 623-207-7190
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 21166742
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-83078
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License Number State | AZ
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