1720304173 NPI number — MAYA HEIM BA, MS, BCBA

Table of content: MAYA HEIM BA, MS, BCBA (NPI 1720304173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720304173 NPI number — MAYA HEIM BA, MS, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEIM
Provider First Name:
MAYA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA, MS, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHALES
Provider Other First Name:
MAYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1720304173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 NE 50TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661-2672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-232-4989
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 JEPSON CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-232-4989
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2010

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117450 . This is a "BEHAVIOR ANALYST LICENSE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 1-09-5831 . This is a "BACB-BOARD CERTIFIED BEHAVIOR ANALYST" identifier . This identifiers is of the category "OTHER".




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