Individual
MS. KELLY RAY HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., BCBA, LBA
Contact information
Practice address
6510 TOWN CENTER DR STE E, CLARKSTON, MI 48346-4822
(248) 277-3005
Mailing address
1620 S HILL CIR, BLOOMFIELD HILLS, MI 48304-1184
(248) 534-0678
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401000984
MI
Other
Enumeration date
01/07/2020
Last updated
08/03/2021
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