Provider Demographics
NPI:1255900205
Name:BRANHAM, LAUREN (BCBA, LBA, QMHP-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:BCBA, LBA, QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 THOMSON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1008
Mailing Address - Country:US
Mailing Address - Phone:804-332-6537
Mailing Address - Fax:
Practice Address - Street 1:1933 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1008
Practice Address - Country:US
Practice Address - Phone:804-332-6537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0733003927101Y00000X
VARBT-16-19611106S00000X
VA0133003985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician