MEDICARE: MARC DEAN JR.

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	:	1265138341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC DEAN JR.

Provider Business Mailing Address
First Line	:	310 S OAK ST APT D
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 S OAK ST APT D
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2453
Country	:	US
Telephone Number	:	989-615-4942
Fax Number	:

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

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	02/01/2023

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Directions to “ MARC DEAN JR. ” Practice Location

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