MEDICARE: MS. LAUREN ALYSE GONZALEZ 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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	5102	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-22-59505	OTHER	TX	BACB
2	RBT-18-66450	OTHER		BACB

General Provider Information

NPI Number	:	1750845814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN ALYSE GONZALEZ BCBA

Provider Business Mailing Address
First Line	:	3000 WESLAYAN ST STE 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5701
Country	:	US
Telephone Number	:	713-218-9947
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 WESLAYAN ST STE 105
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5701
Country	:	US
Telephone Number	:	713-218-9947
Fax Number	:

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

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	06/08/2022

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