Provider Demographics
NPI:1275014557
Name:VERSTRAETE, ELAINNA (BCBA)
Entity type:Individual
Prefix:
First Name:ELAINNA
Middle Name:
Last Name:VERSTRAETE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ELAINNA
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1908 CASCADE LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3425
Mailing Address - Country:US
Mailing Address - Phone:719-432-6937
Mailing Address - Fax:
Practice Address - Street 1:1908 CASCADE LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3425
Practice Address - Country:US
Practice Address - Phone:719-432-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18-62351106S00000X
CO1-22-58951103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician