Healthcare Provider Details

I. General information

NPI: 1356251961
Provider Name (Legal Business Name): ANNABELLE RENEE MATHENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30200 TELEGRAPH RD STE 207
BINGHAM FARMS MI
48025-5711
US

IV. Provider business mailing address

14855 SOUTHVIEW DR
SOUTHGATE MI
48195-3732
US

V. Phone/Fax

Practice location:
  • Phone: 248-712-1129
  • Fax:
Mailing address:
  • Phone: 248-712-1129
  • Fax: 248-792-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: