Provider Demographics
NPI:1376031484
Name:LAZO, KIMBERLY (BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LAZO
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 1:11820 CYPRESS CORNER LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-1132
Mailing Address - Country:US
Mailing Address - Phone:281-894-1423
Mailing Address - Fax:
Practice Address - Street 1:2620 TECHNOLOGY FOREST BLVD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3904
Practice Address - Country:US
Practice Address - Phone:713-388-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX4181103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician