Provider Demographics
NPI:1457802613
Name:SIMONS, LAURA (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SIMONS
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5013
Mailing Address - Country:US
Mailing Address - Phone:808-591-1173
Mailing Address - Fax:
Practice Address - Street 1:564 SOUTH ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5013
Practice Address - Country:US
Practice Address - Phone:808-591-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-17-7623103K00000X
1-21-51209103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst