Provider Demographics
NPI:1235782897
Name:HAGGARD, LAUREN HALEY (BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:HALEY
Last Name:HAGGARD
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 1:4100 CENTRAL PIKE APT 415
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3250
Mailing Address - Country:US
Mailing Address - Phone:205-382-2680
Mailing Address - Fax:
Practice Address - Street 1:4778 OVERTON RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-3803
Practice Address - Country:US
Practice Address - Phone:205-957-0294
Practice Address - Fax:205-957-0298
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2020-084103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2020-084OtherSTATE LICENSE
AL1-20-42561OtherBCBA CERTIFICATION