Provider Demographics
NPI:1831816479
Name:STUCKEY, MALIK (MLS, BCBA)
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:MLS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 UNION BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6514
Mailing Address - Country:US
Mailing Address - Phone:303-989-8169
Mailing Address - Fax:303-984-4366
Practice Address - Street 1:6369 E TANQUE VERDE RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3833
Practice Address - Country:US
Practice Address - Phone:520-276-1274
Practice Address - Fax:520-274-3043
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician