MEDICARE: LOREN LANCASTER 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

General Provider Information

NPI Number	:	1720488323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOREN LANCASTER BCBA

Provider Business Mailing Address
First Line	:	3616 RICHMOND AVE APT 2331
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77046-3643
Country	:	US
Telephone Number	:	832-928-5445
Fax Number	:

Provider Business Practice Location Address
First Line	:	10830 CRAIGHEAD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5804
Country	:	US
Telephone Number	:	713-583-3419
Fax Number	:

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

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	06/21/2022

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