Healthcare Provider Details

I. General information

NPI: 1801386933
Provider Name (Legal Business Name): ZACHARY LUKE MATHYS BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 ELKHART ST NE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

3300 36TH ST SE
GRAND RAPIDS MI
49512-2810
US

V. Phone/Fax

Practice location:
  • Phone: 616-965-3492
  • Fax:
Mailing address:
  • Phone: 616-965-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001933
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-30177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: