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General NPI Number Information
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NPI Number | 1639792658
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Entity Type | Individual
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Provider Name | LAUREN M IMMENSCHUH MA, BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 1850 LOCKHILL SELMA RD STE 106
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City | SAN ANTONIO
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State | TX
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Zip | 78213-1552
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Country | US
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Telephone | 210-643-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 7207 DUBIES DR
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City | SAN ANTONIO
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State | TX
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Zip | 78216-7114
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Country | US
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Telephone | 210-979-1513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-20-113497
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 4315
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License Number State | TX
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