Provider Demographics
NPI:1275287575
Name:HAVERLAND, TAELOUR (BCBA)
Entity type:Individual
Prefix:
First Name:TAELOUR
Middle Name:
Last Name:HAVERLAND
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:TAELOUR
Other - Middle Name:
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:3705 ELLISON RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-7012
Mailing Address - Country:US
Mailing Address - Phone:608-436-9977
Mailing Address - Fax:
Practice Address - Street 1:3705 ELLISON RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-7012
Practice Address - Country:US
Practice Address - Phone:608-436-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-25-80442103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst