Healthcare Provider Details

I. General information

NPI: 1912784430
Provider Name (Legal Business Name): ALYSSA WELCH CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA TAYLOR WELCH BCBA

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2568 CENTRAL AVE
OLLA LA
71465
US

IV. Provider business mailing address

2048 E MADISON AVE
BASTROP LA
71220-4035
US

V. Phone/Fax

Practice location:
  • Phone: 318-376-2535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-70004
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14390
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: