Provider Demographics
NPI:1831648732
Name:SPECHT, LAUREN PETERSON (BCBA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:PETERSON
Last Name:SPECHT
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 1:8969 FULTON DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39335-9437
Mailing Address - Country:US
Mailing Address - Phone:901-258-6011
Mailing Address - Fax:
Practice Address - Street 1:8969 FULTON DR
Practice Address - Street 2:
Practice Address - City:LAUDERDALE
Practice Address - State:MS
Practice Address - Zip Code:39335-9437
Practice Address - Country:US
Practice Address - Phone:901-258-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-23440103K00000X
1-16-23440103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst