Provider Demographics
NPI:1487007852
Name:GLOCKER, KYLE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:GLOCKER
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 N 44TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7244
Mailing Address - Country:US
Mailing Address - Phone:623-263-3996
Mailing Address - Fax:855-913-2517
Practice Address - Street 1:3033 N 44TH ST STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7244
Practice Address - Country:US
Practice Address - Phone:623-263-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-001415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst