Provider Demographics
NPI:1821589532
Name:BAUTISTA MORRIS, GEMA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:GEMA
Middle Name:
Last Name:BAUTISTA MORRIS
Suffix:
Gender:F
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 1:1047 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1802
Mailing Address - Country:US
Mailing Address - Phone:517-442-3127
Mailing Address - Fax:
Practice Address - Street 1:2032 E SQUARE LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3315
Practice Address - Country:US
Practice Address - Phone:248-825-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001610103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst