Healthcare Provider Details

I. General information

NPI: 1932701299
Provider Name (Legal Business Name): MADISON HURTUBISE MA, LBA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 SEMINOLE RD
NORTON SHORES MI
49441-4720
US

IV. Provider business mailing address

2661 LIBERTY RD
NORTON SHORES MI
49441-3445
US

V. Phone/Fax

Practice location:
  • Phone: 231-332-3849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001275
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: