Provider Demographics
NPI:1003472275
Name:LUCERO, SMILE JUNALILZ BALURAN (BCBA)
Entity Type:Individual
Prefix:MS
First Name:SMILE JUNALILZ
Middle Name:BALURAN
Last Name:LUCERO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 HICKMAN MILLS DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1618
Mailing Address - Country:US
Mailing Address - Phone:816-501-5138
Mailing Address - Fax:
Practice Address - Street 1:10330 HICKMAN MILLS DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1618
Practice Address - Country:US
Practice Address - Phone:816-501-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS220103K00000X
MO2019013854103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019013854OtherSTATE LICENSE