1225151293 NPI number — CARY L. CHATHAM-HAHN BCBA

Table of content: CARY L. CHATHAM-HAHN BCBA (NPI 1225151293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225151293 NPI number — CARY L. CHATHAM-HAHN BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHATHAM-HAHN
Provider First Name:
CARY
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225151293
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 85426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85754-5426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-240-1048
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N BONITA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745-2750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-721-1887
Provider Business Practice Location Address Fax Number:
520-207-5963
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: BEH000307 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BEH000307 . This is a "AZ BOARD OF PSYCHOLOGIST EXAMINERS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 364354 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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