Healthcare Provider Details

I. General information

NPI: 1275917841
Provider Name (Legal Business Name): SOPHIE DEVORAH LEFEVRE CTRS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIE DEVORAH LESTER CTRS

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 05/14/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7794 PAINT CREEK DR
YPSILANTI MI
48197-6139
US

IV. Provider business mailing address

3588 PLYMOUTH RD # 393
ANN ARBOR MI
48105-2603
US

V. Phone/Fax

Practice location:
  • Phone: 734-352-3543
  • Fax: 734-547-5462
Mailing address:
  • Phone: 734-352-3543
  • Fax: 734-547-5462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65697
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number66391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: