Healthcare Provider Details

I. General information

NPI: 1790498483
Provider Name (Legal Business Name): SAMARA MARKLE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 MERCANTILE WAY STE 5
LANSING MI
48911-6957
US

IV. Provider business mailing address

6520 MERCANTILE WAY STE 5
LANSING MI
48911-6957
US

V. Phone/Fax

Practice location:
  • Phone: 517-708-8576
  • Fax:
Mailing address:
  • Phone: 517-708-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: