Active NPI
Gwen Micci, M.S., BCBA, LBA
- Behavior Analyst
- Mesa, AZ
National Provider Identifier
1194433425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BEH-000767
- Practice address
- 1255 W Baseline Rd Ste 138B
Mesa, AZ 85202-5821 - Phone
- (602) 859-9692
- NPI assigned
- Nov 7, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BEH-000767 | AZ | Primary |
Addresses
Primary practice location
1255 W Baseline Rd Ste 138B
Mesa, AZ 85202-5821
Mailing address
4540 S Rural Rd Apt C14
Tempe, AZ 85282-7041
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BEH-000767 | AZ | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1194433425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4540 S RURAL RD APT C14",
"city": "TEMPE",
"state": "AZ",
"postal_code": "852827041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1255 W BASELINE RD STE 138B",
"city": "MESA",
"state": "AZ",
"postal_code": "852025821",
"telephone_number": "602-859-9692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICCI",
"first_name": "GWEN",
"credential": "M.S., BCBA, LBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-07",
"last_updated": "2022-11-07",
"certification_date": "2022-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AZ",
"license": "BEH-000767",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.