Provider Demographics
NPI:1639642366
Name:NUSE, JAMES MATTHEW (BCBA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATTHEW
Last Name:NUSE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21701 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2823
Mailing Address - Country:US
Mailing Address - Phone:586-872-7282
Mailing Address - Fax:
Practice Address - Street 1:21701 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2823
Practice Address - Country:US
Practice Address - Phone:586-872-7282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-18-34104103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst