Healthcare Provider Details

I. General information

NPI: 1164156873
Provider Name (Legal Business Name): PEDIATRIC BEHAVIOR SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23708 ROWE ST
DEARBORN MI
48124-1631
US

IV. Provider business mailing address

1250 W 14 MILE RD # 3041
TROY MI
48083-1030
US

V. Phone/Fax

Practice location:
  • Phone: 313-694-5385
  • Fax:
Mailing address:
  • Phone: 313-757-0635
  • 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

VIII. Authorized Official

Name: NATHANIEL PAUL SCHICK
Title or Position: FOUNDER
Credential: BCBA, LBA (MI)
Phone: 313-757-0635