Healthcare Provider Details

I. General information

NPI: 1184118176
Provider Name (Legal Business Name): EMILY LANE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 W ABRIENDO AVE
PUEBLO CO
81004-1128
US

IV. Provider business mailing address

5316 SPARROW HAWK WAY
COLORADO SPRINGS CO
80911-3624
US

V. Phone/Fax

Practice location:
  • Phone: 719-252-3327
  • Fax:
Mailing address:
  • Phone: 303-641-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-62974
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: