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General NPI Number Information
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NPI Number | 1720487226
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Entity Type | Organization
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Legal Business Name | NORTHPOINT PEDIATRIC BEHAVIOR THERAPY
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 302 BARKER DR
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City | MONROE
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State | LA
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Zip | 71203-6544
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Country | US
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Telephone | 318-243-6962
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Fax |
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Provider Business Mailing Address
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Address Line | 302 BARKER DR
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City | MONROE
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State | LA
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Zip | 71203-6544
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Country | US
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Telephone | 318-243-6962
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Fax |
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Authorized Official
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Title or Position | LICENSED BEHAVIOR ANALYST
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Name | MR. BENJAMIN TERRELL NICHOLSON
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Credential | LBA
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Telephone | 318-243-6962
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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-063
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License Number State | LA
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