Provider Demographics
NPI:1205417235
Name:SO, LAUREN MICHALA (BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHALA
Last Name:SO
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 1:3149 E PINTO DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-0508
Mailing Address - Country:US
Mailing Address - Phone:602-579-7961
Mailing Address - Fax:
Practice Address - Street 1:3149 E PINTO DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-0508
Practice Address - Country:US
Practice Address - Phone:602-579-7961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst