Healthcare Provider Details

I. General information

NPI: 1245559988
Provider Name (Legal Business Name): BARRY COUNTY COMMUNITY AUTISM & TELEHEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BARFIELD DR
HASTINGS MI
49058-9018
US

IV. Provider business mailing address

500 BARFIELD DR
HASTINGS MI
49058-9018
US

V. Phone/Fax

Practice location:
  • Phone: 269-948-8041
  • Fax: 269-948-9319
Mailing address:
  • Phone: 269-948-8041
  • Fax: 269-948-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD THIEMKEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 269-948-8041