=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194538629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA ESTHER HARLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2025
-----------------------------------------------------
Last Update Date | 01/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51111 WOODWARD AVE STE 150
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48342-5037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-254-2616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 396 MELINDA CIR
-----------------------------------------------------
City | WHITE LAKE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48386-3460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-678-2744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------