Basic Information
| Provider Information | |||||||||
| NPI: | 1205335965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANADY | ||||||||
| FirstName: | KYANA | ||||||||
| MiddleName: | MAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 E YEAGER DR STE 14 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852861578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805480332 | ||||||||
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| Practice Location | |||||||||
| Address1: | 290 S ALMA SCHOOL RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852247633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183452345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2018 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 1738845 | AZ | N | 103K00000X | BEH-000736 | AZ | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.