Provider Demographics
NPI:1407209711
Name:GOMEZ, LAUREN (M ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4004
Mailing Address - Country:US
Mailing Address - Phone:913-676-2253
Mailing Address - Fax:913-789-3215
Practice Address - Street 1:9100 W 74TH ST
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-4004
Practice Address - Country:US
Practice Address - Phone:913-676-2253
Practice Address - Fax:913-789-3215
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MO2019027697103K00000X
KS103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst