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General NPI Number Information
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NPI Number | 1487276804
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Entity Type | Organization
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Legal Business Name | MICHAELLEB ABA AND CONSULTATION SERVICES
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 05/07/2020
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Provider Practice Location Address
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Address Line | 25147 FORTUNA ST
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City | ROSEVILLE
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State | MI
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Zip | 48066-3795
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Country | US
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Telephone | 260-348-2696
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Fax |
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Provider Business Mailing Address
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Address Line | 3591 LAKEPOINTE ST
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City | DETROIT
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State | MI
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Zip | 48224-3317
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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 | BCBA
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Name | MICHAELLE BERRY
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Credential | LBA
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Telephone | 260-348-2696
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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 |
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License Number State |
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