Provider Demographics
NPI:1629681226
Name:GILMORE, LAUREN PAIGE (BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PAIGE
Last Name:GILMORE
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 1:3000 WESLAYAN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5701
Mailing Address - Country:US
Mailing Address - Phone:713-218-9947
Mailing Address - Fax:713-218-8988
Practice Address - Street 1:3000 WESLAYAN ST STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5701
Practice Address - Country:US
Practice Address - Phone:713-218-9947
Practice Address - Fax:713-218-8988
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12044177103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst