Provider Demographics
NPI:1114423852
Name:BROUWERS, LAUREN FAITH (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:FAITH
Last Name:BROUWERS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:FAITH
Other - Last Name:MCKEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:3800 CAMP CREEK PKWY SW STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-6247
Practice Address - Country:US
Practice Address - Phone:770-999-9271
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-18-30015103K00000X
GA1-21-49647103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300060627Medicaid