Provider Demographics
NPI:1396476859
Name:EDUCATIONAL & BEHAVIORAL CONSERVANCY LLC
Entity type:Organization
Organization Name:EDUCATIONAL & BEHAVIORAL CONSERVANCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BEAUFAIT
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-840-5595
Mailing Address - Street 1:904 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2138
Mailing Address - Country:US
Mailing Address - Phone:248-840-5595
Mailing Address - Fax:
Practice Address - Street 1:904 HILLSIDE CT
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2138
Practice Address - Country:US
Practice Address - Phone:248-840-5595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty