Provider Demographics
NPI:1659118651
Name:EDWARDS, LAKEN A (BCBA)
Entity type:Individual
Prefix:
First Name:LAKEN
Middle Name:A
Last Name:EDWARDS
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 1:7010 DASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8504
Mailing Address - Country:US
Mailing Address - Phone:601-218-7454
Mailing Address - Fax:
Practice Address - Street 1:4988 FAIRFIELD CIR S
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4210
Practice Address - Country:US
Practice Address - Phone:901-827-1115
Practice Address - Fax:901-370-3289
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-24-74078103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst