Individual
LANDON PATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BT
Contact information
Practice address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(318) 795-3388
Mailing address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(318) 795-3388
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-18-64074
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-18-64074
BACB
LA
Enumeration date
09/12/2018
Last updated
09/12/2018
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