Provider Demographics
NPI:1194359943
Name:LACER, CARLEE (BCBA)
Entity type:Individual
Prefix:
First Name:CARLEE
Middle Name:
Last Name:LACER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2004
Mailing Address - Country:US
Mailing Address - Phone:303-960-5096
Mailing Address - Fax:
Practice Address - Street 1:4016 BOULDER DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2004
Practice Address - Country:US
Practice Address - Phone:303-960-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-01
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-67781106S00000X
1-24-77888103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-24-77888OtherBEHAVIOR ANALYST CERTIFICATION BOARD