MEDICARE: CONNOR BEACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1013867712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR BEACH

Provider Business Mailing Address
First Line	:	2805 S INDUSTRIAL HWY STE 100
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-6791
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SAINT ANDREWS RD STE 407
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48638-5977
Country	:	US
Telephone Number	:	989-341-3653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ CONNOR BEACH ” Practice Location

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