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NPI Code Detail

MEDICARE: BETHANY CRANE MED, BCBA

MEDICARE: BETHANY CRANE MED, 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
1103K00000XBehavior Analyst1-16-23722MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-16-23722OTHERMIBCBA CERTIFICATION NUMBER

General Provider Information

NPI Number : 1326597568
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY CRANE MED, BCBA
Provider Business Mailing Address
First Line : 30821 BARRINGTON ST
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-1871
Country : US
Telephone Number : 734-355-2833
Fax Number : 248-331-9919
Provider Business Practice Location Address
First Line : 30821 BARRINGTON ST
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-1871
Country : US
Telephone Number : 734-355-2833
Fax Number : 248-331-9919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2016
Last Update Date : 09/29/2016

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