Provider Demographics
NPI:1487441879
Name:MICHIGAN APPLIED BEHAVIOR ANALYSIS LLC
Entity type:Organization
Organization Name:MICHIGAN APPLIED BEHAVIOR ANALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISSAC
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-403-2344
Mailing Address - Street 1:220 W CONGRESS ST FL 2
Mailing Address - Street 2:#873
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 W CONGRESS ST FL 2
Practice Address - Street 2:#873
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226
Practice Address - Country:US
Practice Address - Phone:313-403-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty