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General NPI Number Information
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NPI Number | 1912784430
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Entity Type | Individual
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Provider Name | ALYSSA WELCH CONNOR
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Gender | Female
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 2568 CENTRAL AVE
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City | OLLA
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State | LA
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Zip | 71465
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Country | US
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Telephone | 318-376-2535
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Fax |
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Provider Business Mailing Address
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Address Line | 2048 E MADISON AVE
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City | BASTROP
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State | LA
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Zip | 71220-4035
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Country | US
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Telephone |
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-23-14390
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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 | 1-23-70004
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License Number State | LA
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