Basic Information
| Provider Information | |||||||||
| NPI: | 1235782897 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGGARD | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | HALEY | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 CENTRAL PIKE APT 415 | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370763250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053822680 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4778 OVERTON RD | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352103803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059570294 | ||||||||
| FaxNumber: | 2059570298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2019 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 2020-084 | AL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 2020-084 | 01 | AL | STATE LICENSE | OTHER | 1-20-42561 | 01 | AL | BCBA CERTIFICATION | OTHER |