Healthcare Provider Details

I. General information

NPI: 1821687468
Provider Name (Legal Business Name): DANIELLE MICHAELS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MARKET ST # 157
TACOMA WA
98402-3737
US

IV. Provider business mailing address

84 23RD AVE
MILTON WA
98354-9346
US

V. Phone/Fax

Practice location:
  • Phone: 253-325-4161
  • Fax:
Mailing address:
  • Phone: 253-921-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberLABA.AB.61136268
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB61089152
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-109485
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-51521
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA61204959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: