=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538316195
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRIS ALLISON LABELLE PH.D., BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2008
-----------------------------------------------------
Last Update Date | 08/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11427 NW 31ST LN
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32606-5258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-562-2771
-----------------------------------------------------
Fax | 352-333-1924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11427 NW 31ST LN
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32606-5258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-562-2771
-----------------------------------------------------
Fax | 352-333-1924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TM1800X
-----------------------------------------------------
Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
-----------------------------------------------------
License Number | BCBA 1-04-1688
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------