1225636590 NPI number — LACI LYN SCATES M.S., BCBA, LBA

Table of content: LACI LYN SCATES M.S., BCBA, LBA (NPI 1225636590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225636590 NPI number — LACI LYN SCATES M.S., BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCATES
Provider First Name:
LACI
Provider Middle Name:
LYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225636590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 INTERNATIONAL PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32746-5028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-915-7729
Provider Business Mailing Address Fax Number:
407-588-6294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
883 SEVEN OAKS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37167-6862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
629-772-8311
Provider Business Practice Location Address Fax Number:
629-206-6961
Provider Enumeration Date:
10/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1151 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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