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Organization
GREAT LAKES BEHAVIORAL SERVICES
Active
Organization
GREAT LAKES BEHAVIORAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTI BRADLEY BCBA (CO-CLINICAL DIRECTOR)
(574) 393-9955
Entity
Organization
Contact information
Practice address
701 N NILES AVE, SOUTH BEND, IN 46617-1923
(574) 393-9955
(574) 393-9956
Mailing address
701 N NILES AVE STE OP102, SOUTH BEND, IN 46617-1923
(574) 393-9955
(574) 393-9956
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/05/2021
Last updated
06/28/2021
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