Provider Demographics
NPI:1982301495
Name:ERNST, MIYAI NICOLE (BCBA)
Entity Type:Individual
Prefix:
First Name:MIYAI
Middle Name:NICOLE
Last Name:ERNST
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 1:31230 SPRINGLAKE BLVD APT 6102
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1110
Mailing Address - Country:US
Mailing Address - Phone:248-986-3427
Mailing Address - Fax:
Practice Address - Street 1:6888 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3032
Practice Address - Country:US
Practice Address - Phone:248-986-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401002009103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst