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General NPI Number Information
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NPI Number | 1770980112
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Entity Type | Organization
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Legal Business Name | ANNEDON BRIGHTON LLC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 10031 SPENCER RD SUITE A
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City | BRIGHTON
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State | MI
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Zip | 48114-3806
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Country | US
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Telephone | 810-344-8082
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Fax | 810-222-0279
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Provider Business Mailing Address
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Address Line | 10031 SPENCER RD SUITE A
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City | BRIGHTON
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State | MI
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Zip | 48114-3806
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Country | US
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Telephone | 810-344-8082
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Fax | 810-222-0279
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | TRACY GRIFFITH
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Credential |
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Telephone | 517-403-9776
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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 | 1-02-1007
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License Number State | MI
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