Healthcare Provider Details

I. General information

NPI: 1922977008
Provider Name (Legal Business Name): JOSE EMANUEL TORRES CORDERO MS, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 TYBEE LN
LAKE CHARLES LA
70605-4172
US

IV. Provider business mailing address

211 LOUIE ST APT 30
LAKE CHARLES LA
70601-7289
US

V. Phone/Fax

Practice location:
  • Phone: 337-240-8162
  • Fax:
Mailing address:
  • Phone: 337-965-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-1070
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: