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NPI Code Detail

MEDICARE: JAMES DEWEY LBA

MEDICARE: JAMES DEWEY LBA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst7401000985MI

General Provider Information

NPI Number : 1790195857
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES DEWEY LBA
Provider Business Mailing Address
First Line : 118 1/2 WOODFORD ST
Second Line :
City : MISSOULA
State : MT
Zip : 59801-4049
Country : US
Telephone Number : 248-633-5713
Fax Number :
Provider Business Practice Location Address
First Line : 955 CAMPUS DR N
Second Line :
City : WATERFORD
State : MI
Zip : 48328-2754
Country : US
Telephone Number : 248-633-5713
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2014
Last Update Date : 02/10/2025

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