MEDICARE: FOOT STEPS ABA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1356935316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT STEPS ABA LLC

Provider Business Mailing Address
First Line	:	2028 N KIRKWOOD DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-4715
Country	:	US
Telephone Number	:	601-874-1992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 N KIRKWOOD DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-4715
Country	:	US
Telephone Number	:	601-874-1992
Fax Number	:

Authorized Official
Title or Position	:	OWNER/BCBA
Name	:	LATISHA ABRAMS BRACEY
Credential	:	BCBA
Telephone Number	:	601-874-1992

Provider Enumeration Date	:	02/21/2021
Last Update Date	:	02/21/2021

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