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NPI Code Detail

MEDICARE: MALLORY COMEAUX

MEDICARE: MALLORY COMEAUX
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystL-812LA

General Provider Information

NPI Number : 1578168951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY COMEAUX
Provider Business Mailing Address
First Line : 1301 SAINT MARY ST
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-6527
Country : US
Telephone Number : 985-446-6833
Fax Number :
Provider Business Practice Location Address
First Line : 1301 SAINT MARY ST
Second Line :
City : THIBODAUX
State : LA
Zip : 70301-6527
Country : US
Telephone Number : 985-446-6833
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2020
Last Update Date : 01/29/2024

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Directions to “ MALLORY COMEAUX ” Practice Location

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