Provider Demographics
NPI:1417236308
Name:DAIGLE, JUSTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:DAIGLE
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:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-0331
Mailing Address - Country:US
Mailing Address - Phone:337-254-0986
Mailing Address - Fax:
Practice Address - Street 1:300 PARK WEST DRIVE, SUITE A
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583
Practice Address - Country:US
Practice Address - Phone:337-254-0986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-11-9057103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst