Healthcare Provider Details

I. General information

NPI: 1073112124
Provider Name (Legal Business Name): LYDIA ONSTOTT BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 ALLEN ST
OWENSBORO KY
42303-3437
US

IV. Provider business mailing address

6905 LUTHER TAYLOR RD
PHILPOT KY
42366-9765
US

V. Phone/Fax

Practice location:
  • Phone: 270-240-1842
  • Fax:
Mailing address:
  • Phone: 270-315-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number292229
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: