Basic Information
| Provider Information | |||||||||
| NPI: | 1912412990 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | CHASITY | ||||||||
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| Credential: | MS, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2920 N ACADEMY BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809175369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194664809 | ||||||||
| FaxNumber: | 7193688399 | ||||||||
| Practice Location | |||||||||
| Address1: | 2920 N ACADEMY BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809175369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194664809 | ||||||||
| FaxNumber: | 7193688399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2017 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | 0-21-12532 | CO | N | 106S00000X | N | 103K00000X | 1-21-55222 | CO | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.