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General NPI Number Information
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NPI Number | 1629546353
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Entity Type | Individual
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Provider Name | MRS. FALLON ALEXANDRA URBANAVAGE
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Gender | Female
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 07/13/2025
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Provider Practice Location Address
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Address Line | 27777 INKSTER RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-5312
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Country | US
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Telephone | 877-299-1655
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Fax |
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Provider Business Mailing Address
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Address Line | 27777 INKSTER RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-5312
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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 |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-67637
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 12153748
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 02011145
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License Number State | FL
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