Provider Demographics
NPI:1689079360
Name:HILTON, BRYAN (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:HILTON
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6429 E JK AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-5843
Mailing Address - Country:US
Mailing Address - Phone:616-634-2923
Mailing Address - Fax:
Practice Address - Street 1:3630 CAPITAL AVE SW
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7375
Practice Address - Country:US
Practice Address - Phone:269-441-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-13-13701103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst