Provider Demographics
NPI:1144872755
Name:FOX, WESLYNN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:WESLYNN
Middle Name:
Last Name:FOX
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:WESLYNN
Other - Middle Name:
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7189 GOODWIN RD
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:MI
Mailing Address - Zip Code:48851-9762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2875 EYDE PKWY
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5368
Practice Address - Country:US
Practice Address - Phone:844-969-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001176103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst