Provider Demographics
NPI:1477958924
Name:LAKHANPAL, AHILYA (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:AHILYA
Middle Name:
Last Name:LAKHANPAL
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CROW CANYON CT STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1679
Mailing Address - Country:US
Mailing Address - Phone:909-436-5424
Mailing Address - Fax:844-262-8466
Practice Address - Street 1:4 CROW CANYON CT STE 150
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1679
Practice Address - Country:US
Practice Address - Phone:094-365-4249
Practice Address - Fax:844-262-8466
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13425103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst