Organization
PANTHEON ABA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAGGIE MARIE KURTZUBA M.A., LBA, BCBA (OWNER/DIRECTOR)
(318) 554-8348
Entity
Organization
Contact information
Practice address
5154 GARLAND DR APT A, LAKE CHARLES, LA 70605-6069
(318) 554-8348
Mailing address
5154 GARLAND DR APT 2, LAKE CHARLES, LA 70605-6069
(318) 554-8348
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/29/2022
Last updated
07/29/2022
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