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General NPI Number Information
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NPI Number | 1457898124
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Entity Type | Organization
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Legal Business Name | SPECTRUM AUTISM CENTER
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 3949 N RIVER RD
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City | FREELAND
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State | MI
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Zip | 48623-8856
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Country | US
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Telephone | 989-702-2082
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Fax |
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Provider Business Mailing Address
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Address Line | 3949 N RIVER RD
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City | FREELAND
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State | MI
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Zip | 48623-8856
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | LEASA ANDROL
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Credential | MA, BCBA
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Telephone | 989-702-2082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | R130461067891
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License Number State | MI
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