Healthcare Provider Details

I. General information

NPI: 1558974808
Provider Name (Legal Business Name): BROOKE ELIZABETH EVANS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ELIZABETH DURBIN BCBA

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5312
US

IV. Provider business mailing address

2505 E JEFFERSON BLVD
SOUTH BEND IN
46615-2635
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003451
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58891
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-51076
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: