Provider Demographics
NPI:1154871671
Name:BEHAVIORAL LEARNING SOLUTIONS, LLC
Entity type:Organization
Organization Name:BEHAVIORAL LEARNING SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, MPH, BCBA
Authorized Official - Phone:732-213-1006
Mailing Address - Street 1:2030 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3286
Mailing Address - Country:US
Mailing Address - Phone:732-213-1006
Mailing Address - Fax:
Practice Address - Street 1:916 FULLER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-1215
Practice Address - Country:US
Practice Address - Phone:732-213-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-14-15924103K00000X
MI68010963951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty