Provider Demographics
NPI:1104326305
Name:EATON, MICHELLE (LBA, BCBA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:EATON
Suffix:
Gender:
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 N 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3852
Mailing Address - Country:US
Mailing Address - Phone:602-842-7218
Mailing Address - Fax:
Practice Address - Street 1:9208 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3852
Practice Address - Country:US
Practice Address - Phone:602-842-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-15-02833106S00000X
CA00001169106S00000X
CA1-18-33607103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician