Provider Demographics
NPI:1033459367
Name:BORTNEM, LAUREN BETH (MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BETH
Last Name:BORTNEM
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23511 SONOMA VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-2038
Mailing Address - Country:US
Mailing Address - Phone:281-804-2257
Mailing Address - Fax:
Practice Address - Street 1:23511 SONOMA VALLEY DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-2038
Practice Address - Country:US
Practice Address - Phone:281-804-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-10-7001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst