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General NPI Number Information
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NPI Number | 1790195857
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Entity Type | Individual
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Provider Name | JAMES DEWEY LBA
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Gender | Male
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 955 CAMPUS DR N
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City | WATERFORD
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State | MI
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Zip | 48328-2754
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Country | US
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Telephone | 248-633-5713
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Fax |
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Provider Business Mailing Address
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Address Line | 118 1/2 WOODFORD ST
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City | MISSOULA
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State | MT
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Zip | 59801-4049
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Country | US
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Telephone | 248-633-5713
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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 |
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License Number State |
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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 | 7401000985
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License Number State | MI
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