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General NPI Number Information
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NPI Number | 1063176071
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Entity Type | Organization
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Legal Business Name | MASTERPIECE BEHAVIOR SERVICES
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 2100 FLOYD PARK DR STE 2
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City | RUSTON
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State | LA
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Zip | 71270-6648
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Country | US
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Telephone | 318-548-1589
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 FLOYD PARK DR STE 2
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City | RUSTON
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State | LA
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Zip | 71270-6648
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Country | US
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Telephone | 318-548-1589
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | MR. JOHN SETH SMITH
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Credential | M.ED., BCBA, LBA
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Telephone | 318-548-1589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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