Healthcare Provider Details

I. General information

NPI: 1306649678
Provider Name (Legal Business Name): TERRA BEHAVIOR THERAPY CENTER FOR AUTISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30150 PLYMOUTH RD
LIVONIA MI
48150-2100
US

IV. Provider business mailing address

30150 PLYMOUTH RD
LIVONIA MI
48150-2100
US

V. Phone/Fax

Practice location:
  • Phone: 313-528-8476
  • Fax:
Mailing address:
  • Phone: 313-528-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ALI ELKHALIL
Title or Position: OWNER
Credential:
Phone: 305-926-0111