Provider Demographics
NPI:1831504778
Name:SMITH, REBECCA (MED, BCBA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44670 ANN ARBOR RD W STE 130
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4085
Mailing Address - Country:US
Mailing Address - Phone:800-409-0096
Mailing Address - Fax:209-975-4142
Practice Address - Street 1:44670 ANN ARBOR RD W STE 130
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4085
Practice Address - Country:US
Practice Address - Phone:800-409-0096
Practice Address - Fax:209-975-4142
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-17-25276103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst