Provider Demographics
NPI:1548574288
Name:LANNON, ALISHA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:
Last Name:LANNON
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:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1081
Mailing Address - Country:US
Mailing Address - Phone:727-510-2720
Mailing Address - Fax:
Practice Address - Street 1:400 PALM DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2611
Practice Address - Country:US
Practice Address - Phone:727-510-2720
Practice Address - Fax:727-545-8429
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-06-2655103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst