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General NPI Number Information
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NPI Number | 1154871671
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL LEARNING SOLUTIONS, LLC
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 916 FULLER ST SUITE 2
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City | ANN ARBOR
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State | MI
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Zip | 48104-1215
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Country | US
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Telephone | 732-213-1006
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 BELMONT ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3286
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Country | US
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Telephone | 732-213-1006
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLA SIMON
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Credential | LMSW, MPH, BCBA
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Telephone | 732-213-1006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-15924
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801096395
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License Number State | MI
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