Provider Demographics
NPI:1265887368
Name:RAYBURN-DEHART, LORI (BCBA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:RAYBURN-DEHART
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 1:2995 BIG PERRY RD
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8156
Mailing Address - Country:US
Mailing Address - Phone:606-465-0786
Mailing Address - Fax:
Practice Address - Street 1:2995 BIG PERRY RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-8156
Practice Address - Country:US
Practice Address - Phone:606-465-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
KY168533103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst