Provider Demographics
NPI:1831539006
Name:BAUCOM, ALISON LORRAINE (MED, BCBA)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:LORRAINE
Last Name:BAUCOM
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26642
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0642
Mailing Address - Country:US
Mailing Address - Phone:512-537-3014
Mailing Address - Fax:
Practice Address - Street 1:700 LAVACA ST
Practice Address - Street 2:STE 1401
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3101
Practice Address - Country:US
Practice Address - Phone:512-537-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-12198103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst