Provider Demographics
NPI:1720406390
Name:WHITE, NATALIA LOUISE (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:LOUISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:SELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:7770 E WRIGHTSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4330
Mailing Address - Country:US
Mailing Address - Phone:520-929-6125
Mailing Address - Fax:
Practice Address - Street 1:7770 E WRIGHTSTOWN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4330
Practice Address - Country:US
Practice Address - Phone:520-929-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000336103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-27059OtherBCBA CERTIFICATE