Provider Demographics
NPI:1255803763
Name:COUGHLIN, LAUREN (BCBA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:COUGHLIN
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 1:6520 MERCANTILE WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6957
Mailing Address - Country:US
Mailing Address - Phone:517-708-8576
Mailing Address - Fax:
Practice Address - Street 1:6520 MERCANTILE WAY STE 5
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6957
Practice Address - Country:US
Practice Address - Phone:517-708-8576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty