Healthcare Provider Details

I. General information

NPI: 1417563370
Provider Name (Legal Business Name): SOUTHERN LOUISIANA BEHAVIOR CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ENERGY PKWY
LAFAYETTE LA
70508-3817
US

IV. Provider business mailing address

111 ENERGY PKWY
LAFAYETTE LA
70508-3817
US

V. Phone/Fax

Practice location:
  • Phone: 337-270-8585
  • Fax: 337-270-8588
Mailing address:
  • Phone: 337-270-8585
  • Fax: 337-270-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BORMAN
Title or Position: OWNER/CEO
Credential:
Phone: 337-270-8585