# GULF SOUTH BR - ABA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871089763
- **Authorized official:** KEVIN J BIANCHINI PH.D. (MANAGING MEMBER)
- **Authorized official phone:** (504) 780-1702

## Contact information

- **Practice address:** 9063 SIEGEN LN STE A, BATON ROUGE, LA 70810
- **Practice address phone:** (504) 780-1702
- **Mailing address:** 2901 N I 10 SERVICE RD E STE 300, METAIRIE, LA 70002-6137
- **Mailing address phone:** (504) 780-1702
- **Mailing address fax:** (504) 780-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 07/03/2018
- **Last updated:** 07/26/2018