Provider Demographics
NPI:1578158911
Name:STUART, PRIMA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:PRIMA
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:PITCHAPOHN
Other - Middle Name:
Other - Last Name:STUART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA, LBA
Mailing Address - Street 1:1009 E SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2020
Mailing Address - Country:US
Mailing Address - Phone:480-286-0656
Mailing Address - Fax:
Practice Address - Street 1:1009 E SANDPIPER DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2020
Practice Address - Country:US
Practice Address - Phone:480-286-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-72880103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBEH-001632OtherLICENSED BEHAVIOR ANALYST (LBA)
1-24-72880OtherBACB CERTIFICATION