Healthcare Provider Details

I. General information

NPI: 1255986758
Provider Name (Legal Business Name): EMMA MARIE SIMCOCK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TERI DEE UNIT C
CADILLAC MI
49601-8318
US

IV. Provider business mailing address

2004 KAYLYNN DR
CADILLAC MI
49601-8210
US

V. Phone/Fax

Practice location:
  • Phone: 231-878-3924
  • Fax:
Mailing address:
  • Phone: 231-878-3924
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: