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General NPI Number Information
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NPI Number | 1174993414
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Entity Type | Organization
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Legal Business Name | SHINETHRU ABA THERAPY, LLP
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 804 HIGHPOINT DR
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2425
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Country | US
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Telephone | 504-884-2679
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Fax |
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Provider Business Mailing Address
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Address Line | 804 HIGHPOINT DR
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2425
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Country | US
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Telephone | 504-884-2679
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | SARA MARGARET MANSILLA
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Credential | BCBA, LBA
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Telephone | 504-884-2679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | L122
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License Number State | LA
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