Destiny Antonia Lake
Individual provider Active NPI Behavior Technician · Weidman, MI
NPI 1942976121 · NPPES record last updated Aug 18, 2021
Key facts
- NPI
- 1942976121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 6151 W Nottawa St
Weidman, MI 48893-9710 - Phone
- (989) 824-8195
- NPI assigned
- Aug 18, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
6151 W Nottawa St
Weidman, MI 48893-9710
Mailing address
6151 W Nottawa St
Weidman, MI 48893-9710
Phone (989) 824-8195
Other providers in Weidman, MI
- Henry P. Szelag, D.O., P.C.
- Hopewell Ranch
- Timothy Hutchins
- Lake Isabella Physical Therapy, LLC
- Lake Isabella Physical Therapy, LLC
- Justin Linda
- Cheryl Lovett
- Angela McNally
- Jennifer Morey Rau
- New Leaf Counseling Services PLLC
All providers in Weidman, MI · Behavior Technician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.