Provider Demographics
NPI:1922722248
Name:REAL REALISTIC EFFECTIVE AUTHENTIC LIFELONG RESULTS AUTISM CENTER
Entity Type:Organization
Organization Name:REAL REALISTIC EFFECTIVE AUTHENTIC LIFELONG RESULTS AUTISM CENTER
Other - Org Name:REAL RESULTS AUTISM CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REALITE
Authorized Official - Middle Name:LANICE
Authorized Official - Last Name:PEEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA LBA
Authorized Official - Phone:269-366-9554
Mailing Address - Street 1:244 BURT ST SE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49548-3236
Mailing Address - Country:US
Mailing Address - Phone:269-366-9554
Mailing Address - Fax:
Practice Address - Street 1:244 BURT ST SE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49548-3236
Practice Address - Country:US
Practice Address - Phone:269-366-9554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty