Individual
JUSTIN LAZENBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
43636 KALIFORNSKY BEACH RD, SOLDOTNA, AK 99669-8264
(907) 931-5548
Mailing address
PO BOX 771324, EAGLE RIVER, AK 99577-1324
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-277413
AK
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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