Provider Demographics
NPI:1659994762
Name:LAUBERT, ALLURA KAYLEN
Entity Type:Individual
Prefix:
First Name:ALLURA
Middle Name:KAYLEN
Last Name:LAUBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8496 BRANCHWATER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-7423
Mailing Address - Country:US
Mailing Address - Phone:904-728-3689
Mailing Address - Fax:
Practice Address - Street 1:8382 BAYMEADOWS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4447
Practice Address - Country:US
Practice Address - Phone:904-728-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB568900106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician