Individual
AMY THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
280 LLOYD LEWIS, GRAND COTEAU, LA 70541
(337) 356-6006
Mailing address
PO BOX 444, GRAND COTEAU, LA 70541-0444
(337) 356-6006
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-13-14414
LA
222Q00000X
Developmental Therapist
—
—
Other
Enumeration date
05/01/2013
Last updated
11/18/2013
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