Active NPI
Dymond Poole
- Behavior Technician
- Dearborn, MI
National Provider Identifier
1174295414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 19853 Outer Dr
Dearborn, MI 48124 - Phone
- (248) 463-8551
- NPI assigned
- Oct 5, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | MI | Primary |
Addresses
Primary practice location
19853 Outer Dr
Dearborn, MI 48124
Mailing address
3530 Ewald Cir
Apt 8a
Detroit, MI 48204
Phone (313) 556-6909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P400159074599 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633392000000",
"number": "1174295414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3530 EWALD CIR",
"address_2": "APT 8A",
"city": "DETROIT",
"state": "MI",
"postal_code": "48204",
"telephone_number": "313-556-6909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19853 OUTER DR",
"city": "DEARBORN",
"state": "MI",
"postal_code": "48124",
"telephone_number": "248-463-8551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOLE",
"first_name": "DYMOND",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-05",
"last_updated": "2021-10-05",
"certification_date": "2021-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "P400159074599",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.