Basic Information
| Provider Information | |||||||||
| NPI: | 1003336546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAN | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1321 MURFREESBORO PIKE STE 702 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372172679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156952277 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18550 W MILLBURN RD | ||||||||
| Address2: | |||||||||
| City: | OLD MILL CREEK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479167375 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2017 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 183-140 | WI | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 1-16-23630 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.