Provider Demographics
NPI:1598375727
Name:LUMPKIN, MARISSA JO (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:JO
Last Name:LUMPKIN
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 1:535 MAINE ST STE 13
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3950
Mailing Address - Country:US
Mailing Address - Phone:217-577-2176
Mailing Address - Fax:888-216-1181
Practice Address - Street 1:535 MAINE ST STE 13
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3950
Practice Address - Country:US
Practice Address - Phone:217-577-2176
Practice Address - Fax:888-216-1181
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-69856103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-23-69856OtherBEHAVIOR ANALYST CERTIFICATION BOARD
BACB577742OtherBEHAVIOR ANALYST CERTIFICATION BOARD