Provider Demographics
NPI:1750172235
Name:BHUTTA, IQRA S (RBT)
Entity type:Individual
Prefix:
First Name:IQRA
Middle Name:S
Last Name:BHUTTA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20778 PRAIRIE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1168
Mailing Address - Country:US
Mailing Address - Phone:734-620-7759
Mailing Address - Fax:
Practice Address - Street 1:29226 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2984
Practice Address - Country:US
Practice Address - Phone:248-450-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician