Healthcare Provider Details

I. General information

NPI: 1306342993
Provider Name (Legal Business Name): NOLA BEHAVIORAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70216 8TH ST
COVINGTON LA
70433-5366
US

IV. Provider business mailing address

70216 8TH ST
COVINGTON LA
70433-5366
US

V. Phone/Fax

Practice location:
  • Phone: 985-492-3315
  • Fax:
Mailing address:
  • Phone: 985-492-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number113
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. KEN MACURIK
Title or Position: BCBA-D
Credential: BCBA-D
Phone: 985-492-3315