Basic Information
| Provider Information | |||||||||
| NPI: | 1164954111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUER | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | |||||||||
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| Credential: | TLLP, BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32100 TELEGRAPH RD | ||||||||
| Address2: | SUITE 185 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480252452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487124266 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 32100 TELEGRAPH RD | ||||||||
| Address2: | SUITE 185 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480252452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487124266 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 12/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6362008744 | MI | N | Behavioral Health & Social Service Providers | Psychologist | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 103K00000X | 7401000649 | MI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.