Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013348648 |
---|---|
Provider Name | Sireece Bass |
First Address | Farmington Hills, MI 48336-5670 |
Second Address | Farmington Hills, MI 48336-5670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2013 |
Last Update Date | 08/12/2013 |