Healthcare Provider Details

I. General information

NPI: 1619739471
Provider Name (Legal Business Name): BEHAVIOR-CISE, ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 ESTATES DR
DETROIT MI
48206-2826
US

IV. Provider business mailing address

1815 ESTATES DR
DETROIT MI
48206-2826
US

V. Phone/Fax

Practice location:
  • Phone: 313-580-1585
  • Fax:
Mailing address:
  • Phone: 313-580-1585
  • 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 Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MARQUISE TOTTY
Title or Position: OWNER, OPERATOR
Credential: BCBA, LBA
Phone: 313-580-1585