Healthcare Provider Details

I. General information

NPI: 1851109367
Provider Name (Legal Business Name): BRIANNA LANDRY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 NE EVANGELINE TRWY
LAFAYETTE LA
70507-2554
US

IV. Provider business mailing address

3420 NE EVANGELINE TRWY
LAFAYETTE LA
70507-2554
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-8679
  • Fax: 337-534-0027
Mailing address:
  • Phone: 337-534-8679
  • Fax: 337-534-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-908
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: