Healthcare Provider Details

I. General information

NPI: 1063176071
Provider Name (Legal Business Name): MASTERPIECE BEHAVIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 FLOYD PARK DR STE 2
RUSTON LA
71270-6648
US

IV. Provider business mailing address

2100 FLOYD PARK DR STE 2
RUSTON LA
71270-6648
US

V. Phone/Fax

Practice location:
  • Phone: 318-548-1589
  • Fax:
Mailing address:
  • Phone: 318-548-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN SETH SMITH
Title or Position: BCBA
Credential: M.ED., BCBA, LBA
Phone: 318-548-1589