MEDICARE: ELIZABETH LANDERS BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-13-13515	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-13-13515	OTHER	CA	BCBA

General Provider Information

NPI Number	:	1356777056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LANDERS BCBA

Provider Business Mailing Address
First Line	:	1055 E COLORADO BLVD STE 560
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2380
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Provider Business Practice Location Address
First Line	:	410 PEACHTREE PKWY STE 4245
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7407
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	08/23/2019

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