Provider Demographics
NPI:1285063271
Name:KING, ANDREW (MS, BCBA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KING
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3660
Mailing Address - Country:US
Mailing Address - Phone:602-535-8341
Mailing Address - Fax:602-682-5929
Practice Address - Street 1:801 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3660
Practice Address - Country:US
Practice Address - Phone:602-535-8341
Practice Address - Fax:602-682-5929
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-13-14595103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-14595OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BACB)