Provider Demographics
NPI:1730428350
Name:BRITTON, LAURA MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BRITTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 COVENTRY PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7111
Mailing Address - Country:US
Mailing Address - Phone:260-750-5480
Mailing Address - Fax:
Practice Address - Street 1:12912 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8870
Practice Address - Country:US
Practice Address - Phone:260-245-1455
Practice Address - Fax:317-815-3861
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-12-12316103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst