Organization
BEHAVIORAL SPECIALISTS OF LA
Active
Other names
Behavioral Specialists of Louisiana
Organization subpart
No
Provider details
NPI number
Authorized official
AMY C BAMBURG (COO/AGENT)
(318) 442-4498
Entity
Organization
Contact information
Practice address
925 OLIVE ST, SHREVEPORT, LA 71104-2103
(318) 300-3560
(318) 300-3561
Mailing address
925 OLIVE STREET, SHREVEPORT, LA 71104
(318) 300-3560
(318) 300-3561
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
LA
103TC0700X
Clinical Psychologist
Primary
—
LA
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2384066
—
LA
Enumeration date
03/12/2015
Last updated
02/14/2018
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