Provider Demographics
NPI:1093166894
Name:LESTER, ALYCIA (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:ALYCIA
Other - Middle Name:MICHELLE
Other - Last Name:HATTOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3401 BERRYWOOD DR STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6515
Mailing Address - Country:US
Mailing Address - Phone:573-777-8349
Mailing Address - Fax:
Practice Address - Street 1:3401 BERRYWOOD DR STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6515
Practice Address - Country:US
Practice Address - Phone:573-777-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MO2017028257103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst