Provider Demographics
NPI:1699039503
Name:BOSTER, LISA K (BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:BOSTER
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 1027
Mailing Address - Street 2:NONE
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7027
Mailing Address - Country:US
Mailing Address - Phone:254-598-8778
Mailing Address - Fax:
Practice Address - Street 1:2016 CEDARHILL DR APT C
Practice Address - Street 2:NONE
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-8997
Practice Address - Country:US
Practice Address - Phone:254-598-8778
Practice Address - Fax:151-223-3264
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst