Provider Demographics
NPI:1427612340
Name:PERKINS, TRACI ANN (BCBA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:ANN
Last Name:PERKINS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:ANN
Other - Last Name:BIRCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1200 N WHITE SANDS BLVD STE 121
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6774
Mailing Address - Country:US
Mailing Address - Phone:866-273-2451
Mailing Address - Fax:
Practice Address - Street 1:1200 N WHITE SANDS BLVD STE 121
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6774
Practice Address - Country:US
Practice Address - Phone:866-273-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001371103K00000X
AZ000454103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst