Healthcare Provider Details

I. General information

NPI: 1265209241
Provider Name (Legal Business Name): MERAKI AUTISM CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S MAIN ST STE 260
PLYMOUTH MI
48170-2089
US

IV. Provider business mailing address

705 S MAIN ST STE 260
PLYMOUTH MI
48170-2089
US

V. Phone/Fax

Practice location:
  • Phone: 734-441-0553
  • Fax:
Mailing address:
  • Phone: 734-441-0553
  • 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 Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNA MARIE MIAH
Title or Position: BEHAVIOR ANALYST / OWNER
Credential: M.ED., BCBA, LBA
Phone: 734-546-1075