Provider Demographics
NPI:1730770900
Name:ALLEN, LUVERT (BCBA)
Entity type:Individual
Prefix:
First Name:LUVERT
Middle Name:
Last Name:ALLEN
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 1:900 BUICE LAKE PKWY APT 6209
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-8424
Mailing Address - Country:US
Mailing Address - Phone:404-771-7497
Mailing Address - Fax:
Practice Address - Street 1:25 POINTE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-2755
Practice Address - Country:US
Practice Address - Phone:404-932-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-21-153232106S00000X
GA1-23-68207103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician