Provider Demographics
NPI:1356601363
Name:BRUMMEL, LORI (BCBA)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:BRUMMEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:EDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20100 S WESTERN AVE # R05
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1307
Mailing Address - Country:US
Mailing Address - Phone:310-971-4778
Mailing Address - Fax:
Practice Address - Street 1:20100 S WESTERN AVE # R05
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1307
Practice Address - Country:US
Practice Address - Phone:310-971-4778
Practice Address - Fax:213-600-0145
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X, 103K00000X, 103TC1900X, 103TS0200X, 103TS0200X
MI7401000896103K00000X
CA01-09-6434103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling