Organization
GULF SOUTH BR - ABA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J BIANCHINI PH.D. (MANAGING MEMBER)
(504) 780-1702
Entity
Organization
Contact information
Practice address
9063 SIEGEN LN STE A, BATON ROUGE, LA 70810
(504) 780-1702
Mailing address
2901 N I 10 SERVICE RD E STE 300, METAIRIE, LA 70002-6137
(504) 780-1702
(504) 780-1705
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
07/03/2018
Last updated
07/26/2018
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