Provider Demographics
NPI:1528647476
Name:PANTER, LAURA MICHELLE (MS, BCBA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MICHELLE
Last Name:PANTER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SHEPPARD ACCESS RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-4235
Mailing Address - Country:US
Mailing Address - Phone:940-867-7929
Mailing Address - Fax:940-386-2101
Practice Address - Street 1:3501 SHEPPARD ACCESS RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-4235
Practice Address - Country:US
Practice Address - Phone:940-224-9032
Practice Address - Fax:940-386-2101
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-22-62470103K00000X
RBT-17-45384106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician