Provider Demographics
NPI:1558753780
Name:RILEY, ALYSSA A (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:A
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:525 TOLL ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2848
Mailing Address - Country:US
Mailing Address - Phone:734-286-4927
Mailing Address - Fax:
Practice Address - Street 1:444 N HEWITT RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1844
Practice Address - Country:US
Practice Address - Phone:248-846-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIS315064067985247200000X
MI7401000778103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other