Provider Demographics
NPI:1285988352
Name:SMITH, MALLORY RAYE (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:RAYE
Last Name:SMITH
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Gender:F
Credentials:MA, BCBA
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Mailing Address - Street 1:1835 E GUADALUPE RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3277
Mailing Address - Country:US
Mailing Address - Phone:480-659-5456
Mailing Address - Fax:480-838-1828
Practice Address - Street 1:1835 E GUADALUPE RD
Practice Address - Street 2:SUITE #103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3277
Practice Address - Country:US
Practice Address - Phone:480-659-5456
Practice Address - Fax:480-838-1828
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZBA-193103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst