Provider Demographics
NPI:1487271599
Name:LUNDY, MARSHALL PARKER (BCBA)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:PARKER
Last Name:LUNDY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 MILLBRANCH RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1672
Mailing Address - Country:US
Mailing Address - Phone:601-543-4041
Mailing Address - Fax:
Practice Address - Street 1:32 MILLBRANCH RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1672
Practice Address - Country:US
Practice Address - Phone:601-255-5264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS170042103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst