Provider Demographics
NPI:1831899871
Name:CANVAS ABA PLLC
Entity type:Organization
Organization Name:CANVAS ABA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOUCHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPSY, BCBA, LBA
Authorized Official - Phone:810-228-5248
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-0118
Mailing Address - Country:US
Mailing Address - Phone:810-228-5248
Mailing Address - Fax:
Practice Address - Street 1:3249 E WILSON RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9743
Practice Address - Country:US
Practice Address - Phone:810-228-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty