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General NPI Number Information
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NPI Number | 1366027559
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Entity Type | Organization
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Legal Business Name | ARKLATEX ABA, LLC
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 7330 FERN AVE STE 1103
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City | SHREVEPORT
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State | LA
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Zip | 71105-4989
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Country | US
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Telephone | 318-264-8818
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Fax |
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Provider Business Mailing Address
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Address Line | 7330 FERN AVE STE 1103
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City | SHREVEPORT
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State | LA
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Zip | 71105-4989
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Country | US
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Telephone | 318-264-8818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA LEGG
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Credential | BCBA
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Telephone | 318-264-8818
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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 |
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License Number State |
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