Provider Demographics
NPI:1861057440
Name:PETERS, SIERRA (BCBA)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:1601 S MOPAC EXPY STE C300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7077
Mailing Address - Country:US
Mailing Address - Phone:512-920-1030
Mailing Address - Fax:
Practice Address - Street 1:22362 E DOMINGO RD
Practice Address - Street 2:SUITE 106
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142
Practice Address - Country:US
Practice Address - Phone:602-922-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-21-50882103K00000X
106S00000X
AZBEH-001504103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300052026Medicaid