Provider Demographics
NPI:1326597568
Name:CRANE, BETHANY (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:CRANE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:DUDLETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30821 BARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1871
Mailing Address - Country:US
Mailing Address - Phone:734-355-2833
Mailing Address - Fax:248-331-9919
Practice Address - Street 1:30821 BARRINGTON ST
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1871
Practice Address - Country:US
Practice Address - Phone:734-355-2833
Practice Address - Fax:248-331-9919
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-16-23722103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1-16-23722OtherBCBA CERTIFICATION NUMBER