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General NPI Number Information
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NPI Number | 1841014644
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Entity Type | Organization
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Legal Business Name | FOOTPRINTS ABA THERAPY LLC
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Dates
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Enumeration Date | 11/09/2024
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Last Update Date | 11/09/2024
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Provider Practice Location Address
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Address Line | 598 AUGUSTINE DR
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City | LAKE CHARLES
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State | LA
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Zip | 70611-4625
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Country | US
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Telephone | 337-250-5334
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Fax |
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Provider Business Mailing Address
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Address Line | 598 AUGUSTINE DR
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City | LAKE CHARLES
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State | LA
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Zip | 70611-4625
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Country | US
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Telephone | 337-250-5334
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR
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Name | NICOLE ARDOIN
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Credential | BCBA LBA
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Telephone | 337-250-5334
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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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