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General NPI Number Information
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NPI Number | 1831899871
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Entity Type | Organization
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Legal Business Name | CANVAS ABA PLLC
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 3249 E WILSON RD
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City | CLIO
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State | MI
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Zip | 48420-9743
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Country | US
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Telephone | 810-228-5248
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 118
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City | CLIO
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State | MI
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Zip | 48420-0118
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Country | US
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Telephone | 810-228-5248
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Fax |
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Authorized Official
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Title or Position | OWNER & CLINICAL DIRECTOR
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Name | NATASHA ANN BOUCHILLON
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Credential | MSPSY, BCBA, LBA
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Telephone | 810-228-5248
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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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