NPIMap

Organization Active NPI

Functional Behavior Services, LLC

  • Behavior Analyst
  • Marquette, MI
National Provider Identifier
1780044404
Registry record updated Jan 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-14-15411 Issued in MI
Legal business name
FUNCTIONAL BEHAVIOR SERVICES, LLC
Practice address
1229 W Washington St Ste 5
Marquette, MI 49855-3186
Phone
(906) 273-1121
Fax
(906) 225-6706
NPI assigned
Feb 24, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carrissa Rondeau, BCBA, LLMSW
Title
Bcba
Phone
(069) 273-1121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X 1-14-15411 MI Primary

Addresses

Primary practice location

1229 W Washington St Ste 5
Marquette, MI 49855-3186

Mailing address

N5625 Nummela Rd
Skandia, MI 49885-9755
Phone (906) 439-5290

National Provider Directory

National Provider Directory

Locations

1229 W Washington St
Ste 5
Marquette, MI 49855
Phone (906) 273-1121

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580083200000",
    "number": "1780044404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N5625 NUMMELA RD",
            "city": "SKANDIA",
            "state": "MI",
            "postal_code": "498859755",
            "telephone_number": "906-439-5290",
            "fax_number": "906-439-5279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1229 W WASHINGTON ST STE 5",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498553186",
            "telephone_number": "906-273-1121",
            "fax_number": "906-225-6706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL BEHAVIOR SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-24",
        "last_updated": "2020-01-27",
        "certification_date": "2020-01-27",
        "status": "A",
        "authorized_official_last_name": "RONDEAU",
        "authorized_official_first_name": "CARRISSA",
        "authorized_official_title_or_position": "BCBA",
        "authorized_official_telephone_number": "069-273-1121",
        "authorized_official_credential": "BCBA, LLMSW"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": "MI",
            "license": "1-14-15411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marquette, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.