Individual
JACOB MATTHEW TYRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, BCBA, LBA
Contact information
Practice address
1840 N 95TH AVE STE 140, PHOENIX, AZ 85037-4446
(623) 264-8188
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-001038
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-22-62453
BCBA CERTIFICATE
—
Enumeration date
07/03/2019
Last updated
02/13/2023
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