Healthcare Provider Details

I. General information

NPI: 1194359943
Provider Name (Legal Business Name): CARLEE LACER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 BOULDER DR
LOVELAND CO
80538-2004
US

IV. Provider business mailing address

4016 BOULDER DR
LOVELAND CO
80538-2004
US

V. Phone/Fax

Practice location:
  • Phone: 303-960-5096
  • Fax:
Mailing address:
  • Phone: 303-960-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-77888
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-67781
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: