Healthcare Provider Details

I. General information

NPI: 1215214671
Provider Name (Legal Business Name): LIVE OAK BEHAVIORAL PSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2011
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 LOUIS PRIMA DR SUITE A
COVINGTON LA
70433-5903
US

IV. Provider business mailing address

56 LOUIS PRIMA DR SUITE A
COVINGTON LA
70433-5903
US

V. Phone/Fax

Practice location:
  • Phone: 504-450-7561
  • Fax:
Mailing address:
  • Phone: 985-327-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-065
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7333
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTT.200847
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1175
License Number StateLA

VIII. Authorized Official

Name: DR. LACEY LEBLANC SEYMOUR
Title or Position: LICENSED PSYCHOLOGIST, DIRECTOR
Credential: PH.D., BCBA-D
Phone: 985-327-7256