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NPI Code Detail

MEDICARE: JADE ELLIS GARRETT BCBA

MEDICARE: JADE ELLIS GARRETT 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 AnalystBACB515655MS

General Provider Information

NPI Number : 1669104170
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE ELLIS GARRETT BCBA
Provider Business Mailing Address
First Line : 27777 INKSTER RD STE 100
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-5312
Country : US
Telephone Number : 855-772-8847
Fax Number :
Provider Business Practice Location Address
First Line : 9040 ROSWELL RD STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30350-1863
Country : US
Telephone Number : 855-772-8847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2022
Last Update Date : 10/28/2025

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