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NPI Code Detail

MEDICARE: RACHEL MUTOMBO BCBA, LBA

MEDICARE: RACHEL MUTOMBO BCBA, LBA
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
1106S00000XBehavior Technician
2103K00000XBehavior AnalystL-787LA

General Provider Information

NPI Number : 1811686744
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL MUTOMBO BCBA, LBA
Provider Business Mailing Address
First Line : 139 JAMES COMEAUX RD STE B
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3376
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Provider Business Practice Location Address
First Line : 139 JAMES COMEAUX RD STE B
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3376
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2023
Last Update Date : 05/15/2024

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