MEDICARE: AMBER HALIBURTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	171M00000X	Case Manager/Care Coordinator		MI

General Provider Information

NPI Number	:	1164925723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER HALIBURTON

Provider Business Mailing Address
First Line	:	1685 BALDWIN AVE
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48340-1242
Country	:	US
Telephone Number	:	248-706-3450
Fax Number	:

Provider Business Practice Location Address
First Line	:	1685 BALDWIN AVE STE 100
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48340-1242
Country	:	US
Telephone Number	:	248-706-3450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2018
Last Update Date	:	05/30/2024

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Directions to “ AMBER HALIBURTON ” Practice Location

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