Provider Demographics
NPI:1235899600
Name:CREAR, STACI LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:LYNN
Last Name:CREAR
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:LYNN
Other - Last Name:RYBACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2150 S COUNTRY CLUB DR STE 36
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6886
Mailing Address - Country:US
Mailing Address - Phone:619-339-5596
Mailing Address - Fax:877-602-5087
Practice Address - Street 1:2150 S COUNTRY CLUB DR STE 36
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6886
Practice Address - Country:US
Practice Address - Phone:619-339-5596
Practice Address - Fax:877-602-5087
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-15-18942103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1225206444Medicaid