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General NPI Number Information
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NPI Number | 1538788922
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Entity Type | Individual
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Provider Name | DAVID ALAN FAIRBURN JR. MA, BCBA, LBA
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Gender | Male
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 38450 SUNNY DAYS LN
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City | SLIDELL
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State | LA
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Zip | 70461-4603
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Country | US
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Telephone | 985-288-5508
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Fax |
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Provider Business Mailing Address
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Address Line | 19142 NULL RD
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City | LORANGER
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State | LA
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Zip | 70446-2516
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Country | US
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Telephone | 985-662-2594
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | L-437
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License Number State | LA
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