Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1205238425 |
---|---|
Provider Name | Michael Hixson |
First Address | Mt Pleasant, MI 48859-0001 |
Second Address | Mt Pleasant, MI 48859-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 18/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1-02-0984 | BEHAVIOR ANALYST CERTIFICATION (01) | MI |