Provider Demographics
NPI:1457584476
Name:VAN DORN, ELIZABETH TUNELL (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:TUNELL
Last Name:VAN DORN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:TUNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:PO BOX 1522
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-5403
Mailing Address - Country:US
Mailing Address - Phone:815-981-8012
Mailing Address - Fax:
Practice Address - Street 1:105 DARTMOUTH DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-7445
Practice Address - Country:US
Practice Address - Phone:815-981-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2017-081103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst