Provider Demographics
NPI:1215761432
Name:HALL, LORA TEVIS (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:TEVIS
Last Name:HALL
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 BENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4019
Mailing Address - Country:US
Mailing Address - Phone:859-436-5934
Mailing Address - Fax:
Practice Address - Street 1:1721 BENWOOD DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4019
Practice Address - Country:US
Practice Address - Phone:859-436-5934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1-20-45537103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst