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NPI Code Detail

MEDICARE: STEPHANIE RAY B.A., BCABA, LABA

MEDICARE: STEPHANIE RAY B.A., BCABA, LABA
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
1106S00000XBehavior Technician
2222Q00000XDevelopmental Therapist
3106E00000XAssistant Behavior Analyst0-22-13532FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295184711
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE RAY B.A., BCABA, LABA
Provider Business Mailing Address
First Line : PO BOX 663
Second Line :
City : LAKELAND
State : MI
Zip : 48143-0663
Country : US
Telephone Number : 734-203-0181
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 : 06/06/2016
Last Update Date : 07/08/2024

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