Individual
MALLORY ANNE FANDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA PBA, BCABA
Contact information
Practice address
3999 HIGHWAY 190 EAST SERVICE RD, COVINGTON, LA 70433-4914
(985) 871-0689
Mailing address
3999 HIGHWAY 190 EAST SERVICE RD, COVINGTON, LA 70433-4914
(985) 871-0689
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
L-271
LA
106E00000X
Assistant Behavior Analyst
C015
LA
Other
Enumeration date
09/28/2017
Last updated
07/21/2022
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