Provider Demographics
NPI:1811364128
Name:LESSER, MICHELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LESSER
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 1:2517 ENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3715
Mailing Address - Country:US
Mailing Address - Phone:612-205-4969
Mailing Address - Fax:
Practice Address - Street 1:2517 ENFIELD RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3715
Practice Address - Country:US
Practice Address - Phone:612-205-4969
Practice Address - Fax:866-302-4553
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-18961103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-15-18961OtherBCBA