Provider Demographics
NPI:1639467434
Name:CASPER M.A., BCBA, LBA, LAURA (MA BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:CASPER M.A., BCBA, LBA
Suffix:
Gender:F
Credentials:MA BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22804 SE 268TH PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6878
Mailing Address - Country:US
Mailing Address - Phone:727-505-1575
Mailing Address - Fax:
Practice Address - Street 1:22910 SE 271ST PL
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-7951
Practice Address - Country:US
Practice Address - Phone:727-505-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALEAD BEHAVIOR ANALYSOtherDEPT OF HEALTH
1-00-0087OtherBCBA
WACL 60340417OtherDEPT OF HEALTH