Provider Demographics
NPI:1215724661
Name:MACIAS, AUDREE
Entity type:Individual
Prefix:
First Name:AUDREE
Middle Name:
Last Name:MACIAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 N KOLB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4149
Mailing Address - Country:US
Mailing Address - Phone:520-505-2810
Mailing Address - Fax:602-581-3026
Practice Address - Street 1:2090 N KOLB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4149
Practice Address - Country:US
Practice Address - Phone:520-505-2810
Practice Address - Fax:602-581-3026
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician