Healthcare Provider Details

I. General information

NPI: 1235612763
Provider Name (Legal Business Name): JAMES C BLEVINS BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5111 AUTO CLUB DR STE 200
DEARBORN MI
48126-2749
US

IV. Provider business mailing address

5111 AUTO CLUB DR STE 200
DEARBORN MI
48126-2749
US

V. Phone/Fax

Practice location:
  • Phone: 313-406-5056
  • Fax: 248-712-4381
Mailing address:
  • Phone: 313-406-5056
  • Fax: 248-712-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: