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General NPI Number Information
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NPI Number | 1467194316
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Entity Type | Organization
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Legal Business Name | CENTER FOR BEHAVIOR ANALYTIC SERVICES, LLC
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 924 LAKE DR
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City | FULTON
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State | MS
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Zip | 38843-8936
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Country | US
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Telephone | 706-254-1688
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Fax |
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Provider Business Mailing Address
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Address Line | 924 LAKE DR
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City | FULTON
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State | MS
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Zip | 38843-8936
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Country | US
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Telephone | 706-254-1688
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SHARON D BOUDREAUX
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Credential | BCBA, LBA
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Telephone | 706-254-1688
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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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