Provider Demographics
NPI:1912721283
Name:GRAY, LAUREN KARLIE (BCBA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KARLIE
Last Name:GRAY
Suffix:
Gender:F
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:PO BOX 66726
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63166-6726
Mailing Address - Country:US
Mailing Address - Phone:314-432-6200
Mailing Address - Fax:314-432-8894
Practice Address - Street 1:611 N FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-7244
Practice Address - Country:US
Practice Address - Phone:573-339-9300
Practice Address - Fax:573-339-7964
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst