Provider Demographics
NPI:1619739471
Name:BEHAVIOR-CISE, ABA
Entity Type:Organization
Organization Name:BEHAVIOR-CISE, ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARQUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTTY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:313-580-1585
Mailing Address - Street 1:1815 ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-2826
Mailing Address - Country:US
Mailing Address - Phone:313-580-1585
Mailing Address - Fax:
Practice Address - Street 1:1815 ESTATES DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2826
Practice Address - Country:US
Practice Address - Phone:313-580-1585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty