Provider Demographics
NPI:1336813963
Name:CHENEY, ELAYNA
Entity Type:Individual
Prefix:
First Name:ELAYNA
Middle Name:
Last Name:CHENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:T.R.A.C. THERAPY RESEARCH AUTISM CENTER
Mailing Address - Street 2:10751 SOUTH SAGINAW STREET SUITE E
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:989-513-0782
Mailing Address - Fax:
Practice Address - Street 1:T.R.A.C. THERAPY RESEARCH AUTISM CENTER
Practice Address - Street 2:10751 SOUTH SAGINAW STREET SUITE E
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439
Practice Address - Country:US
Practice Address - Phone:989-513-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician