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General NPI Number Information
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NPI Number | 1235573502
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Entity Type | Individual
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Provider Name | JAMES MACON BCBA
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Gender | Male
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 7375 WOODWARD AVE STE 2800
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City | DETROIT
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State | MI
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Zip | 48202-3157
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Country | US
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Telephone | 137-108-7443
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Fax | 855-568-2494
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Provider Business Mailing Address
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Address Line | 1027 BALDWIN ST
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City | DETROIT
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State | MI
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Zip | 48214-2430
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Country | US
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Telephone | 605-371-6387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7401000206
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License Number State | MI
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