Great Lakes Behavioral Services
NPI #1144818295 in South Bend, Indiana
Provider Information
- NPI Number
- 1144818295
- Entity Type
- Organization
- Organization Name
- Great Lakes Behavioral Services
- Primary Specialty
- Behavior Analyst
- Enumeration Date
- Jan 5, 2021
- Last Updated
- Jun 28, 2021
Practice Location
- Address
- 701 N NILES AVE
- City
- South Bend
- State
- Indiana
- ZIP Code
- 46617-1923
- Phone
- (574) 393-9955
Authorized Official
- Name
- SHANTI BRADLEY, BCBA
- Title
- CO-CLINICAL DIRECTOR
- Phone
- (574) 393-9955
Specialties & Taxonomy Codes
| Specialty |
|---|
| Behavior Analyst |
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