Provider Demographics
NPI:1255957130
Name:BOLTON, BRITTLEE LAUREN (BCBA)
Entity type:Individual
Prefix:
First Name:BRITTLEE
Middle Name:LAUREN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRITT
Other - Middle Name:LAUREN
Other - Last Name:BOLTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:4510 PREMIER DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8349
Practice Address - Country:US
Practice Address - Phone:336-568-6122
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-20-44099103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst