MEDICARE: REBECCA CLINTON M.ED., 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	101Y00000X	Counselor	CG60463952	WA
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1841610128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA CLINTON M.ED., BCBA

Provider Business Mailing Address
First Line	:	1363 DOUGLAS DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8980
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1363 DOUGLAS DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-8980
Country	:	US
Telephone Number	:	231-668-4909
Fax Number	:

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

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	02/20/2019

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