Individual
DESTINI MATHEWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
628 COMMERCIAL PKWY STE 2, WEST MONROE, LA 71292-8062
(318) 245-4113
(318) 588-8909
Mailing address
PO BOX 1823, WEST MONROE, LA 71294-1823
(318) 588-8908
(318) 588-8909
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L-821
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-24-71631
BACB
—
Enumeration date
02/09/2023
Last updated
05/03/2024
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