Healthcare Provider Details

I. General information

NPI: 1003438052
Provider Name (Legal Business Name): INSPIRE AUTISM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 10/10/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39525 W 14 MILE RD STE 100
NOVI MI
48377-1635
US

IV. Provider business mailing address

39525 W 14 MILE RD STE 100
NOVI MI
48377-1635
US

V. Phone/Fax

Practice location:
  • Phone: 248-417-4237
  • Fax:
Mailing address:
  • Phone: 248-417-4237
  • 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
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PAYTON BOUDREAU
Title or Position: FOUNDER/CCO
Credential: BCBA, LBA
Phone: 248-417-4237