Healthcare Provider Details

I. General information

NPI: 1912894015
Provider Name (Legal Business Name): LYNDI ELLISON BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5328 LANIER ISLANDS PKWY UNIT 101
BUFORD GA
30518-9071
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 470-655-1970
  • Fax:
Mailing address:
  • Phone: 407-807-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82090
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: