Provider Demographics
NPI:1730461161
Name:ELLIOTT, LAUREN REBECCA (BCBA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:REBECCA
Last Name:ELLIOTT
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 1:7070 GRELOT RD
Mailing Address - Street 2:APT. 322
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2642
Mailing Address - Country:US
Mailing Address - Phone:334-332-6207
Mailing Address - Fax:251-649-1164
Practice Address - Street 1:7070 GRELOT RD
Practice Address - Street 2:APT. 322
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-2642
Practice Address - Country:US
Practice Address - Phone:334-332-6207
Practice Address - Fax:251-649-1164
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-10-7914103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst