MEDICARE: COI PERHASE BCBA

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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst	0133002388	VA

General Provider Information

NPI Number	:	1104346857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COI PERHASE BCBA

Provider Business Mailing Address
First Line	:	6404 FLUSHING RD
Second Line	:
City	:	FLUSHING
State	:	MI
Zip	:	48433-2551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 COMMONWEALTH PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4517
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

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

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	01/05/2026

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Directions to “ COI PERHASE BCBA” Practice Location

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