Provider Demographics
NPI:1013272814
Name:LARNED, COLLEEN S (MS, BCBA, COBA)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:S
Last Name:LARNED
Suffix:
Gender:F
Credentials:MS, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1309
Mailing Address - Country:US
Mailing Address - Phone:814-450-7978
Mailing Address - Fax:
Practice Address - Street 1:1403 CHURCHILL RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1309
Practice Address - Country:US
Practice Address - Phone:814-450-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-11-7964103K00000X
PA1-11-7964103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst