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Individual

JENNIFER LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.ED. BCBA LBA

Contact information

Practice address
9559 HIGHWAY 5 STE 601, DOUGLASVILLE, GA 30135-1572
(470) 632-5276
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-45159
GA
103K00000X
Behavior Analyst
1-20-45159
TX

Other

Enumeration date
11/06/2020
Last updated
02/20/2024
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