Provider Demographics
NPI:1114495330
Name:BRELAND, LINDSEY (BCBA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BRELAND
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 1:7125 HITT RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4431
Mailing Address - Country:US
Mailing Address - Phone:251-422-1827
Mailing Address - Fax:
Practice Address - Street 1:7125 HITT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4431
Practice Address - Country:US
Practice Address - Phone:251-422-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2020-25103K00000X
ALRBT-18-53114106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-18-53114OtherREGISTERED BEHAVIOR TECHNICIAN
AL84286940OtherBCBS, TRICARE, BEACON, ALL KIDS