Healthcare Provider Details

I. General information

NPI: 1396658985
Provider Name (Legal Business Name): CARLEE LYNN CANAL BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 OLIVER RD STE 8
MONROE LA
71201-5757
US

IV. Provider business mailing address

209 WOODMONT DR
MONROE LA
71203-7307
US

V. Phone/Fax

Practice location:
  • Phone: 318-523-1141
  • Fax:
Mailing address:
  • Phone: 318-789-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-1161
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: