Provider Demographics
NPI:1235550088
Name:ABA THERAPIES OF CENTRAL MICHIGAN, LLC
Entity Type:Organization
Organization Name:ABA THERAPIES OF CENTRAL MICHIGAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:352-650-8563
Mailing Address - Street 1:11984 E. STANTON RD.
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:MI
Mailing Address - Zip Code:48889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11984 E STANTON RD
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:MI
Practice Address - Zip Code:48889-9796
Practice Address - Country:US
Practice Address - Phone:352-650-8563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health