Provider Demographics
NPI:1184223422
Name:KILLION, LAUREN (M,ED, LBS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KILLION
Suffix:
Gender:F
Credentials:M,ED, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 BURHOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2411
Mailing Address - Country:US
Mailing Address - Phone:215-514-4082
Mailing Address - Fax:
Practice Address - Street 1:7626 BURHOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2411
Practice Address - Country:US
Practice Address - Phone:215-514-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003855103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst