Provider Demographics
NPI:1194020446
Name:BAIN, ELYSE LENORE HUNT (BCBA)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:LENORE HUNT
Last Name:BAIN
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 1:5900 HOLLIS ST STE X
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2008
Mailing Address - Country:US
Mailing Address - Phone:510-500-5124
Mailing Address - Fax:
Practice Address - Street 1:5900 HOLLIS ST STE X
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2008
Practice Address - Country:US
Practice Address - Phone:850-521-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-12-11893103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst