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General NPI Number Information
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NPI Number | 1841847712
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Entity Type | Individual
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Provider Name | STEFAN MATTHEWS
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Gender | Male
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Dates
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Enumeration Date | 08/24/2019
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 17520 OLD JEFFERSON HWY
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-3903
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Country | US
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Telephone | 225-300-6710
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Fax |
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Provider Business Mailing Address
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Address Line | 105 DOGWOOD DR
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City | LAFAYETTE
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State | LA
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Zip | 70501-3109
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Country | US
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Telephone | 337-446-6845
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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 | 011307154
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | L-984
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License Number State | LA
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