Provider Demographics
NPI:1336672757
Name:EMBREE, LACY MARIE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LACY
Middle Name:MARIE
Last Name:EMBREE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:LACY
Other - Middle Name:MARIE
Other - Last Name:ALDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10065 OLD GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1664
Mailing Address - Country:US
Mailing Address - Phone:858-444-8823
Mailing Address - Fax:
Practice Address - Street 1:10065 OLD GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1664
Practice Address - Country:US
Practice Address - Phone:858-444-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-17-25315103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst