Provider Demographics
NPI:1265965388
Name:JOHNS, MAKENZIE (BCBA)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:JOHNS
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 1:43431 CLAREMONT DR E # 137
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3578
Mailing Address - Country:US
Mailing Address - Phone:419-572-1588
Mailing Address - Fax:
Practice Address - Street 1:53869 CONNOR DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3930
Practice Address - Country:US
Practice Address - Phone:312-914-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-25090103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst