Organization
ARIZONA ABA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JILL MARIE COONEY RBT (CLINICAL DIRECTOR)
(928) 600-2190
Entity
Organization
Contact information
Practice address
10325 N LUNAR DR, FLAGSTAFF, AZ 86004-3154
(307) 629-6779
Mailing address
10325 N LUNAR DR, FLAGSTAFF, AZ 86004-3154
(307) 629-6779
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548712235
—
VA
Enumeration date
07/17/2022
Last updated
07/17/2022
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