Healthcare Provider Details

I. General information

NPI: 1710314562
Provider Name (Legal Business Name): NABERHAUS THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46200 PORT ST
PLYMOUTH MI
48170
US

IV. Provider business mailing address

9357 GENERAL DR SUITE 101
PLYMOUTH MI
48170-4662
US

V. Phone/Fax

Practice location:
  • Phone: 734-454-0866
  • Fax: 734-454-1744
Mailing address:
  • Phone: 734-454-0866
  • Fax: 734-454-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADLEY J NABERHAUS
Title or Position: PRESIDENT
Credential:
Phone: 734-454-0866