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NPI Code Detail

MEDICARE: CHRISTY WAHL MA, BCBA

MEDICARE: CHRISTY WAHL MA, 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 Analyst1-1829703MI

General Provider Information

NPI Number : 1912458415
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTY WAHL MA, BCBA
Provider Business Mailing Address
First Line : 10031 SPENCER RD
Second Line :
City : BRIGHTON
State : MI
Zip : 48114-3806
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10031 SPENCER RD
Second Line :
City : BRIGHTON
State : MI
Zip : 48114-3806
Country : US
Telephone Number : 810-229-4334
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2016
Last Update Date : 04/18/2018

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