Healthcare Provider Details

I. General information

NPI: 1881939346
Provider Name (Legal Business Name): CREATING BRIGHTER FUTURES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 VARSITY DR
ANN ARBOR MI
48108-5005
US

IV. Provider business mailing address

4201 VARSITY DR
ANN ARBOR MI
48108-5005
US

V. Phone/Fax

Practice location:
  • Phone: 734-926-0740
  • Fax: 734-369-8851
Mailing address:
  • Phone: 734-926-0740
  • Fax: 734-369-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA IRISH
Title or Position: CLINICAL DIRECTOR
Credential: BCBA
Phone: 734-926-0740