Basic Information
| Provider Information | |||||||||
| NPI: | 1992245633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERRY | ||||||||
| FirstName: | LAURYN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A., BCBA, COBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 ARLINGTON CENTRE BLVD | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432203075 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5000 ARLINGTON CENTRE BLVD | ||||||||
| Address2: | BUILDING 2 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432203075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146155145 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2017 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
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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 | 1-16-23788 | OH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.