Provider Demographics
NPI:1376946954
Name:COLE, LAUREN (BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:COLE
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 1:5820 STONERIDGE MALL RD
Mailing Address - Street 2:#325
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3274
Mailing Address - Country:US
Mailing Address - Phone:855-278-5500
Mailing Address - Fax:
Practice Address - Street 1:5820 STONERIDGE MALL RD
Practice Address - Street 2:#325
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3274
Practice Address - Country:US
Practice Address - Phone:855-278-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-9938103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst