Healthcare Provider Details

I. General information

NPI: 1427507672
Provider Name (Legal Business Name): BRADLEY ROSS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SW RAILROAD AVE STE 240A
HAMMOND LA
70403-5064
US

IV. Provider business mailing address

1105 HUDSON LN
MONROE LA
71201-6003
US

V. Phone/Fax

Practice location:
  • Phone: 985-277-1996
  • Fax: 985-277-1984
Mailing address:
  • Phone: 318-322-6500
  • Fax: 318-750-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-185
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: