Provider Demographics
NPI:1104392034
Name:SMITH, JOHN SETH (BCBA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SETH
Last Name:SMITH
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 FLOYD PARK DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-6648
Mailing Address - Country:US
Mailing Address - Phone:318-548-1589
Mailing Address - Fax:
Practice Address - Street 1:2100 FLOYD PARK DR STE 2
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-6648
Practice Address - Country:US
Practice Address - Phone:318-548-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-326103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst