Provider Demographics
NPI:1376926162
Name:ABA CONNECTIONS OF CENTRAL MICHIGAN, LLC
Entity Type:Organization
Organization Name:ABA CONNECTIONS OF CENTRAL MICHIGAN, LLC
Other - Org Name:ABA CONNECTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARCELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:989-839-2290
Mailing Address - Street 1:3301 RIDGECREST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-5860
Mailing Address - Country:US
Mailing Address - Phone:989-839-2290
Mailing Address - Fax:844-273-4297
Practice Address - Street 1:3301 RIDECREST DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642
Practice Address - Country:US
Practice Address - Phone:989-839-2290
Practice Address - Fax:844-273-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-14525103K00000X
1-00-0120103K00000X
MI6301015991103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty