Provider Demographics
NPI:1275069726
Name:HAVENS, LANCE (BCBA)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:
Last Name:HAVENS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1759 OCEANSIDE BLVD STE C118
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3470
Mailing Address - Country:US
Mailing Address - Phone:213-915-8277
Mailing Address - Fax:844-609-0034
Practice Address - Street 1:1759 OCEANSIDE BLVD STE C118
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3470
Practice Address - Country:US
Practice Address - Phone:213-915-8277
Practice Address - Fax:844-609-0034
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-21047103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst