Provider Demographics
NPI:1366044539
Name:PENG, YI-HSUAN (BCBA)
Entity type:Individual
Prefix:
First Name:YI-HSUAN
Middle Name:
Last Name:PENG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2323 E GREENLAW LN STE 12A
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2323 E GREENLAW LN STE 12A
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1849
Practice Address - Country:US
Practice Address - Phone:928-275-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABA61114127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst