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General NPI Number Information
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NPI Number | 1518691617
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Entity Type | Individual
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Provider Name | JEFF PIERRE LOUIS
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Gender | Male
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 9815 CROSS PINE CT
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City | LAKE WORTH
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State | FL
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Zip | 33467-2367
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Country | US
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Telephone | 754-368-5845
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Fax |
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Provider Business Mailing Address
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Address Line | 5834 EAGLE CAY CIR
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City | COCONUT CREEK
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State | FL
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Zip | 33073-2606
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Country | US
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Telephone | 954-534-3893
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB705418
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License Number State |
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