Provider Demographics
NPI:1154105278
Name:LAU, ISAAC RICHARD (RBT)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:RICHARD
Last Name:LAU
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E YONGE ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-3765
Mailing Address - Country:US
Mailing Address - Phone:918-282-4742
Mailing Address - Fax:
Practice Address - Street 1:84 EMARIE GREY CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-0637
Practice Address - Country:US
Practice Address - Phone:918-282-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-283023106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician