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NPI Code Detail

MEDICARE: LAWRENCE BAUTISTA M.S., BCBA

MEDICARE: LAWRENCE BAUTISTA M.S., BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-13-14572CA
2103K00000XBehavior Analyst1-13-14572GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-13-14572OTHERCABCBA

General Provider Information

NPI Number : 1639500705
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAWRENCE BAUTISTA M.S., BCBA
Provider Business Mailing Address
First Line : 27777 INKSTER RD STE 100
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-5312
Country : US
Telephone Number : 248-220-7980
Fax Number :
Provider Business Practice Location Address
First Line : 9040 ROSWELL RD STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30350-1863
Country : US
Telephone Number : 248-220-7980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2013
Last Update Date : 04/23/2025

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