Provider Demographics
NPI:1174022420
Name:KLINE, LAUREN CRUM (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:CRUM
Last Name:KLINE
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2266 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6488
Mailing Address - Country:US
Mailing Address - Phone:602-856-1957
Mailing Address - Fax:
Practice Address - Street 1:2266 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6488
Practice Address - Country:US
Practice Address - Phone:602-856-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000413103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-31695OtherBCBA CERTIFICATE