Provider Demographics
NPI:1639662208
Name:EIDELSAFY, AKRUM (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:AKRUM
Middle Name:
Last Name:EIDELSAFY
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2468
Mailing Address - Country:US
Mailing Address - Phone:810-321-3019
Mailing Address - Fax:810-321-3002
Practice Address - Street 1:8285 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2468
Practice Address - Country:US
Practice Address - Phone:810-321-3019
Practice Address - Fax:810-321-3002
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000688103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst