Basic Information
| Provider Information | |||||||||
| NPI: | 1508592932 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GABRE | ||||||||
| FirstName: | MOGOS | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4530 E MUIRWOOD DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806106981 | ||||||||
| FaxNumber: | 4808987419 | ||||||||
| Practice Location | |||||||||
| Address1: | 4530 E MUIRWOOD DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806106981 | ||||||||
| FaxNumber: | 4808987419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2022 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BEH-000923 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.