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NPI Code Detail

MEDICARE: MRS. LAUREN LULEY EDS, BCBA

MEDICARE:  MRS. LAUREN  LULEY  EDS, 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 Analyst1-18-33392IN

General Provider Information

NPI Number : 1932729175
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREN LULEY EDS, BCBA
Provider Business Mailing Address
First Line : 6716 VERANDAH LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-9268
Country : US
Telephone Number : 260-615-5430
Fax Number :
Provider Business Practice Location Address
First Line : 4118 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-1210
Country : US
Telephone Number : 260-267-0767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2020
Last Update Date : 06/09/2025

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