Provider Demographics
NPI:1205296027
Name:RICHMOND, JENNIFER (BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MI
Mailing Address - Zip Code:48818-9657
Mailing Address - Country:US
Mailing Address - Phone:989-287-2699
Mailing Address - Fax:
Practice Address - Street 1:507 S NELSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2197
Practice Address - Country:US
Practice Address - Phone:616-303-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000757103K00000X
MI1-17-27067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst