Healthcare Provider Details

I. General information

NPI: 1962892935
Provider Name (Legal Business Name): TAUREN KEELS M.ED, LBA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15930 19 MILE RD STE 201
CLINTON TOWNSHIP MI
48038-1155
US

IV. Provider business mailing address

2200 CROOKS RD APT 41
TROY MI
48084-5323
US

V. Phone/Fax

Practice location:
  • Phone: 586-464-0175
  • Fax:
Mailing address:
  • Phone: 248-795-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401000327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: