Healthcare Provider Details

I. General information

NPI: 1477066447
Provider Name (Legal Business Name): CAMERON DOUGLAS MCCRIRIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W HIGHLAND RD
HOWELL MI
48843
US

IV. Provider business mailing address

138 W HIGHLAND RD
HOWELL MI
48843-2168
US

V. Phone/Fax

Practice location:
  • Phone: 517-376-4831
  • Fax: 517-376-4833
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-59189
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: