=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326784810
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREW BEHAVIOR THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2022
-----------------------------------------------------
Last Update Date | 05/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 N 19TH ST
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71201-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-372-4280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2539 HIGHWAY 151
-----------------------------------------------------
City | DOWNSVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71234-5124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-372-4280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/BCBA
-----------------------------------------------------
Name | MAGGIE FRANKLIN
-----------------------------------------------------
Credential | MS, BCBA, LBA
-----------------------------------------------------
Telephone | 317-372-4280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------