Provider Demographics
NPI:1932729175
Name:LULEY, LAUREN (EDS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:LULEY
Suffix:
Gender:F
Credentials:EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 VERANDAH LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9268
Mailing Address - Country:US
Mailing Address - Phone:260-615-5430
Mailing Address - Fax:
Practice Address - Street 1:4118 N CLINTON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1210
Practice Address - Country:US
Practice Address - Phone:260-267-0767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-18-33392103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst