Provider Demographics
NPI:1407582331
Name:WATKINS, BROOKE ALEXANDRA (MA, LBA, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:ALEXANDRA
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MA, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6067 AVA LN
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647-6534
Mailing Address - Country:US
Mailing Address - Phone:337-274-4557
Mailing Address - Fax:
Practice Address - Street 1:3026 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8513
Practice Address - Country:US
Practice Address - Phone:337-240-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-652103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst