Healthcare Provider Details

I. General information

NPI: 1235550088
Provider Name (Legal Business Name): ABA THERAPIES OF CENTRAL MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11984 E STANTON RD
SUMNER MI
48889-9796
US

IV. Provider business mailing address

11984 E. STANTON RD.
SUMNER MI
48889
US

V. Phone/Fax

Practice location:
  • Phone: 352-650-8563
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN RICHARDSON
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: BCBA
Phone: 352-650-8563