Organization
SPROUTS BEHAVIOR DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYDNA STONE OAKLEY (OWNER/BCBA)
(337) 377-7772
Entity
Organization
Contact information
Practice address
4819 IHLES RD, LAKE CHARLES, LA 70605
(337) 377-7772
Mailing address
4819 IHLES RD, LAKE CHARLES, LA 70605-5900
(337) 602-6247
(337) 602-6062
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2351567
—
LA
Enumeration date
04/18/2016
Last updated
07/25/2018
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