Healthcare Provider Details

I. General information

NPI: 1730461161
Provider Name (Legal Business Name): LAUREN REBECCA ELLIOTT BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7070 GRELOT RD APT. 322
MOBILE AL
36695-2642
US

IV. Provider business mailing address

7070 GRELOT RD APT. 322
MOBILE AL
36695-2642
US

V. Phone/Fax

Practice location:
  • Phone: 334-332-6207
  • Fax: 251-649-1164
Mailing address:
  • Phone: 334-332-6207
  • Fax: 251-649-1164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7914
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: